{"hospital_name":"SAINT JOSEPH HEALTH SYSTEM, INC","last_updated_on":"2026-02-28","version":"3.0.0","location_name": ["CHI Saint Joseph Health - Saint Joseph Hospital"],"hospital_address": ["1 Saint Joseph Drive, Lexington, KY 40504"],"license_information":{"license_number":"100117","state":"KY"},"type_2_npi": ["1437150984"],"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":"Jarrett Millsaps , President"},"standard_charge_information":[{"description":"HEART TRANSPLANT OR IMPLANT OF HEART ASSIST SYSTEM WITH MCC","code_information":[{"code":"001","type":"MS-DRG"}],"standard_charges":[{"minimum":169718.19,"maximum":416835,"setting":"inpatient","payers_information":[{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_percentage":55,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_percentage":51,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":397001.58,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":352514,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":416835,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":384497,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":169718.19,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":198004.55,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":188575.76,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":192347.28,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":192347.28,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":192347.28,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":204455.82,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":199493.3,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":198500.79,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":208425.83,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":203463.31,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":198500.79,"methodology":"case rate"}]}]},{"description":"HEART TRANSPLANT OR IMPLANT OF HEART ASSIST SYSTEM WITHOUT MCC","code_information":[{"code":"002","type":"MS-DRG"}],"standard_charges":[{"minimum":66573.72,"maximum":163070,"setting":"inpatient","payers_information":[{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_percentage":55,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_percentage":51,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":155727.96,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":137907,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":163070,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":150419,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":66573.72,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":77669.33,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":73970.79,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":75450.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":75450.21,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":75450.21,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":80199.9,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":78253.3,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":77863.98,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":81757.18,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":79810.58,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":77863.98,"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":129198.64,"maximum":317145,"setting":"inpatient","payers_information":[{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_percentage":55,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_percentage":51,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":302219.02,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":268207,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":317145,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":292541,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":129198.64,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":150731.75,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":143554.04,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":146425.13,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":146425.13,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":146425.13,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":155642.8,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":151865.06,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":151109.51,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":158664.99,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":154887.25,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":151109.51,"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":85281.38,"maximum":209096,"setting":"inpatient","payers_information":[{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_percentage":55,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_percentage":51,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":199488.58,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":176831,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":209096,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":192874,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":85281.38,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":99494.94,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":94757.08,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":96652.23,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":96652.23,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":96652.23,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":102736.62,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":100243.02,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":99744.29,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":104731.51,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":102237.9,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":99744.29,"methodology":"case rate"}]}]},{"description":"HC CT CEREBRAL PERFUSION ANS","code_information":[{"code":"0042T","type":"CPT"},{"code":"0350","type":"RC"}],"standard_charges":[{"minimum":389.48,"maximum":389.48,"gross_charge":428,"discounted_cash":201.63,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":389.48,"methodology":"fee schedule"}]}]},{"description":"HC CT CEREBRAL PERFUSION ANS","code_information":[{"code":"0042T","type":"CPT"},{"code":"0350","type":"RC"}],"standard_charges":[{"minimum":100.54,"maximum":1094,"gross_charge":428,"discounted_cash":201.63,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":269.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":269.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":269.64,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":354,"standard_charge_algorithm": "Lesser of $354.00 or 100 Percent of Billed Charges","median_amount":226.8,"10th_percentile":222.86,"90th_percentile":226.88,"count":"13","methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":340,"standard_charge_algorithm": "Lesser of $340.00 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|All Other Plans","standard_charge_dollar":269.64,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":269.64,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":389.14,"standard_charge_algorithm": "Lesser of $389.14 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":389.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1094,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":350.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":115.56,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":121.34,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":113.25,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":100.54,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":117.88,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":119.03,"methodology":"fee schedule"}]}]},{"description":"LIVER TRANSPLANT WITH MCC OR INTESTINAL TRANSPLANT","code_information":[{"code":"005","type":"MS-DRG"}],"standard_charges":[{"minimum":64346.45,"maximum":157590,"setting":"inpatient","payers_information":[{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_percentage":55,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_percentage":51,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":150518,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":133272,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":157590,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":145364,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":64346.45,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":75070.86,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":71496.05,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":72925.98,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":72925.98,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":72925.98,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":77516.77,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":75635.3,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":75259,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":79021.95,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":77140.48,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":75259,"methodology":"case rate"}]}]},{"description":"LIVER TRANSPLANT WITHOUT MCC","code_information":[{"code":"006","type":"MS-DRG"}],"standard_charges":[{"minimum":29459.72,"maximum":71758,"setting":"inpatient","payers_information":[{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_percentage":55,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_percentage":51,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":68911.62,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":60686,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":71758,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":66192,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":29459.72,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":34369.68,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":32733.02,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":33387.69,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":33387.69,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":33387.69,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":35489.49,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":34628.09,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":34455.81,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":36178.61,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":35317.21,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":34455.81,"methodology":"case rate"}]}]},{"description":"LUNG TRANSPLANT","code_information":[{"code":"007","type":"MS-DRG"}],"standard_charges":[{"minimum":78898.53,"maximum":193392,"setting":"inpatient","payers_information":[{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_percentage":55,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_percentage":51,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":184557.94,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":163550,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":193392,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":178389,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":78898.53,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":92048.29,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":87665.03,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":89418.34,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":89418.34,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":89418.34,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":95047.34,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":92740.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":92278.97,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":96892.92,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":94585.95,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":92278.97,"methodology":"case rate"}]}]},{"description":"HC PLACE STENT/CHEST VRT ART","code_information":[{"code":"0075T","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":8631.35,"maximum":8631.35,"gross_charge":9485,"discounted_cash":4468.23,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":8631.35,"methodology":"fee schedule"}]}]},{"description":"HC PLACE STENT/CHEST VRT ART","code_information":[{"code":"0075T","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":2228.03,"maximum":8631.35,"gross_charge":9485,"discounted_cash":4468.23,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5975.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5975.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5975.55,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5975.55,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":5975.55,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":8631.35,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4552.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":7113.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":2560.95,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":2689,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":2509.74,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":2228.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2612.17,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2637.78,"methodology":"fee schedule"}]}]},{"description":"HC TCAT PLMT XTRC VRT CRTD STENT RS&IPRQ EA VSL","code_information":[{"code":"0076T","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":7376.46,"maximum":7376.46,"gross_charge":8106,"discounted_cash":3818.6,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":7376.46,"methodology":"fee schedule"}]}]},{"description":"HC TCAT PLMT XTRC VRT CRTD STENT RS&IPRQ EA VSL","code_information":[{"code":"0076T","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":1904.1,"maximum":7376.46,"gross_charge":8106,"discounted_cash":3818.6,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5106.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5106.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5106.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5106.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":5106.78,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":7376.46,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3890.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":6079.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":2188.62,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":2298.06,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":2144.85,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":1904.1,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2232.4,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2254.28,"methodology":"fee schedule"}]}]},{"description":"SIMULTANEOUS PANCREAS AND KIDNEY TRANSPLANT","code_information":[{"code":"008","type":"MS-DRG"}],"standard_charges":[{"minimum":33019.85,"maximum":80517,"setting":"inpatient","payers_information":[{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_percentage":55,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_percentage":51,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":77239.4,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":68093,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":80517,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":74271,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":33019.85,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":38523.16,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":36688.72,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":37422.5,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":37422.5,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":37422.5,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":39778.3,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":38812.8,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":38619.7,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":40550.69,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":39585.2,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":38619.7,"methodology":"case rate"}]}]},{"description":"PANCREAS TRANSPLANT","code_information":[{"code":"010","type":"MS-DRG"}],"standard_charges":[{"minimum":48248.58,"maximum":117984,"setting":"inpatient","payers_information":[{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_percentage":55,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_percentage":51,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":112862.16,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":99779,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":117984,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":108831,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":48248.58,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":56290.01,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":53609.53,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":54681.73,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":54681.73,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":54681.73,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":58124.02,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":56713.24,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":56431.08,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":59252.64,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":57841.86,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":56431.08,"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":32747.99,"maximum":81246,"setting":"inpatient","payers_information":[{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":81246,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":72650,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":76603.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":67527,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":79849,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":73654,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":32747.99,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":38205.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":36386.65,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":37114.39,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":37114.39,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":37114.39,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":39450.79,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":38493.24,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":38301.73,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":40216.82,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":39259.28,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":38301.73,"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":24975.73,"maximum":61789,"setting":"inpatient","payers_information":[{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":61789,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":55252,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":58422.74,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":51356,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":60727,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":56016,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":24975.73,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":29138.36,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":27750.81,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":28305.83,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":28305.83,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":28305.83,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":30087.72,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":29357.43,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":29211.37,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":30671.94,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":29941.66,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":29211.37,"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":16232.1,"maximum":39901,"setting":"inpatient","payers_information":[{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":39901,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":35680,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":37969.8,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":33164,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":39215,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":36172,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":16232.1,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":18937.45,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":18035.66,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":18396.38,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":18396.38,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":18396.38,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":19554.45,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":19079.83,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":18984.9,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":19934.15,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":19459.53,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":18984.9,"methodology":"case rate"}]}]},{"description":"ALLOGENEIC BONE MARROW TRANSPLANT","code_information":[{"code":"014","type":"MS-DRG"}],"standard_charges":[{"minimum":79097.02,"maximum":193880,"setting":"inpatient","payers_information":[{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_percentage":55,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_percentage":51,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":185022.24,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":163963,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":193880,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":178840,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":79097.02,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":92279.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":87885.57,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":89643.29,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":89643.29,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":89643.29,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":95286.46,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":92973.68,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":92511.12,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":97136.68,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":94823.9,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":92511.12,"methodology":"case rate"}]}]},{"description":"HC LAB KARIUS TEST","code_information":[{"code":"0152U","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":4852.12,"maximum":4852.12,"gross_charge":5332,"discounted_cash":2511.82,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4852.12,"methodology":"fee schedule"}]}]},{"description":"HC LAB KARIUS TEST","code_information":[{"code":"0152U","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":13.28,"maximum":4852.12,"gross_charge":5332,"discounted_cash":2511.82,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3359.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3359.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3359.16,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","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":"BCBS - Anthem","plan_name":"Commercial|Pathway","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":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":4252.4,"standard_charge_algorithm": "Lesser of $4252.40 or 200 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3359.16,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3359.16,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4852.12,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2126.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":3892.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":2126.2,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":2232.51,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":2126.2,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":2126.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2168.72,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2168.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2189.99,"standard_charge_algorithm": "Lesser of $2189.99 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":2126.2,"standard_charge_algorithm": "Lesser of $2126.20 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2126.2,"standard_charge_algorithm": "Lesser of $2126.20 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":2232.51,"standard_charge_algorithm": "Lesser of $2232.51 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2211.25,"standard_charge_algorithm": "Lesser of $2211.25 or 104 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":2126.2,"standard_charge_algorithm": "Lesser of $2126.20 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"AUTOLOGOUS BONE MARROW TRANSPLANT WITH CC/MCC","code_information":[{"code":"016","type":"MS-DRG"}],"standard_charges":[{"minimum":36597.42,"maximum":89319,"setting":"inpatient","payers_information":[{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_percentage":55,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_percentage":51,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":85607.98,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":75537,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":89319,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":82390,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":36597.42,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":42696.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":40663.8,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":41477.08,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":41477.08,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":41477.08,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":44088.11,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":43018.01,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":42803.99,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":44944.19,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":43874.09,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":42803.99,"methodology":"case rate"}]}]},{"description":"AUTOLOGOUS BONE MARROW TRANSPLANT WITHOUT CC/MCC","code_information":[{"code":"017","type":"MS-DRG"}],"standard_charges":[{"minimum":36597.42,"maximum":89319,"setting":"inpatient","payers_information":[{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_percentage":55,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_percentage":51,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":85607.98,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":75537,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":89319,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":82390,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":36597.42,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":42696.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":40663.8,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":41477.08,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":41477.08,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":41477.08,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":44088.11,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":43018.01,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":42803.99,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":44944.19,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":43874.09,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":42803.99,"methodology":"case rate"}]}]},{"description":"CHIMERIC ANTIGEN RECEPTOR (CAR) T-CELL AND OTHER IMMUNOTHERAPIES","code_information":[{"code":"018","type":"MS-DRG"}],"standard_charges":[{"minimum":227125.92,"maximum":567842,"setting":"inpatient","payers_information":[{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":567842,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":507765,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":531288.68,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":471959,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":558074,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":514780,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":227125.92,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":264980.24,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":252362.13,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":257409.38,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":257409.38,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":257409.38,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":273613.68,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":266972.57,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":265644.34,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":278926.56,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":272285.45,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":265644.34,"methodology":"case rate"}]}]},{"description":"SIMULTANEOUS PANCREAS AND KIDNEY TRANSPLANT WITH HEMODIALYSIS","code_information":[{"code":"019","type":"MS-DRG"}],"standard_charges":[{"minimum":47973.71,"maximum":119361,"setting":"inpatient","payers_information":[{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":119361,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":106733,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":112219.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":99207,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":117308,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":108208,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":47973.71,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":55969.33,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":53304.12,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":54370.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":54370.21,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":54370.21,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":57792.88,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":56390.14,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":56109.59,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":58915.07,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":57512.33,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":56109.59,"methodology":"case rate"}]}]},{"description":"INTRACRANIAL VASCULAR PROCEDURES WITH PRINCIPAL DIAGNOSIS HEMORRHAGE WITH MCC","code_information":[{"code":"020","type":"MS-DRG"}],"standard_charges":[{"minimum":48778.48,"maximum":121376,"setting":"inpatient","payers_information":[{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":121376,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":108535,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":114101.7,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":100881,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":119288,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":110034,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":48778.48,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":56908.23,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":54198.31,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":55282.28,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":55282.28,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":55282.28,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":58762.38,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":57336.11,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":57050.85,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":59903.4,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":58477.13,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":57050.85,"methodology":"case rate"}]}]},{"description":"HC NFCT DS BCT/VIR RESPIR DNA/RNA 22 TRGT SARSCOV2","code_information":[{"code":"0202U","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":1006.46,"maximum":1006.46,"gross_charge":1106,"discounted_cash":521.02,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1006.46,"methodology":"fee schedule"}]}]},{"description":"HC NFCT DS BCT/VIR RESPIR DNA/RNA 22 TRGT SARSCOV2","code_information":[{"code":"0202U","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":166.71,"maximum":1006.46,"gross_charge":1106,"discounted_cash":521.02,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":696.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":696.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":696.78,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":166.71,"standard_charge_algorithm": "Lesser of $166.71 or 100 Percent of Billed Charges","median_amount":569.87,"10th_percentile":264.49,"90th_percentile":586.29,"count":"1 through 10","methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":166.71,"standard_charge_algorithm": "Lesser of $166.71 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":833.56,"standard_charge_algorithm": "Lesser of $833.56 or 200 Percent of Billed Charges","median_amount":833.56,"10th_percentile":833.56,"90th_percentile":833.56,"count":"1 through 10","methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":696.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":696.78,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1006.46,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":416.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":807.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":416.78,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":437.62,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":416.78,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":416.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":425.12,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":425.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","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":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":416.78,"standard_charge_algorithm": "Lesser of $416.78 or 100 Percent of Billed Charges","median_amount":416.78,"10th_percentile":416.78,"90th_percentile":416.78,"count":"1 through 10","methodology":"fee schedule"},{"payer_name":"Humana","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":"Passport by Molina","plan_name":"Medicare|All Plans","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":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":433.45,"standard_charge_algorithm": "Lesser of $433.45 or 104 Percent of Billed Charges","median_amount":431.37,"10th_percentile":431.37,"90th_percentile":431.37,"count":"1 through 10","methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":416.78,"standard_charge_algorithm": "Lesser of $416.78 or 100 Percent of Billed Charges","median_amount":416.78,"10th_percentile":416.78,"90th_percentile":416.78,"count":"1 through 10","methodology":"fee schedule"}]}]},{"description":"INTRACRANIAL VASCULAR PROCEDURES WITH PRINCIPAL DIAGNOSIS HEMORRHAGE WITH CC","code_information":[{"code":"021","type":"MS-DRG"}],"standard_charges":[{"minimum":33538.32,"maximum":83225,"setting":"inpatient","payers_information":[{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":83225,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":74420,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":78452.2,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":69172,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":81793,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":75448,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":33538.32,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":39128.04,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":37264.8,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":38010.1,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":38010.1,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":38010.1,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":40402.89,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":39422.24,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":39226.1,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":41187.41,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":40206.76,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":39226.1,"methodology":"case rate"}]}]},{"description":"INTRACRANIAL VASCULAR PROCEDURES WITH PRINCIPAL DIAGNOSIS HEMORRHAGE WITHOUT CC/MCC","code_information":[{"code":"022","type":"MS-DRG"}],"standard_charges":[{"minimum":21527.47,"maximum":53157,"setting":"inpatient","payers_information":[{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":53157,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":47533,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":50356.64,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":44181,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":52243,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":48190,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":21527.47,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":25115.39,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":23919.41,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":24397.8,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":24397.8,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":24397.8,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":25933.67,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":25304.22,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":25178.32,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":26437.24,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":25807.78,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":25178.32,"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":34607.74,"maximum":85902,"setting":"inpatient","payers_information":[{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":85902,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":76813,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":80953.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":71397,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":84424,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":77875,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":34607.74,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":40375.7,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":38453.04,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":39222.11,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":39222.11,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":39222.11,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":41691.19,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":40679.27,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":40476.88,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":42500.73,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":41488.81,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":40476.88,"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":23159.27,"maximum":57242,"setting":"inpatient","payers_information":[{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":57242,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":51186,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":54173.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":47577,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":56258,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":51893,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":23159.27,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":27019.15,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":25732.52,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":26247.18,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":26247.18,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":26247.18,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":27899.47,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":27222.3,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":27086.86,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":28441.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":27764.04,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":27086.86,"methodology":"case rate"}]}]},{"description":"COVID/FLU A/B TRIPLEX","code_information":[{"code":"0240U","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":99.19,"maximum":99.19,"gross_charge":109,"discounted_cash":51.35,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":99.19,"methodology":"fee schedule"}]}]},{"description":"COVID/FLU A/B TRIPLEX","code_information":[{"code":"0240U","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":57.05,"maximum":149.76,"gross_charge":109,"discounted_cash":51.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":68.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":68.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":68.67,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":57.05,"standard_charge_algorithm": "Lesser of $57.05 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":57.05,"standard_charge_algorithm": "Lesser of $57.05 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|All Other Plans","standard_charge_dollar":68.67,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":68.67,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":99.19,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":142.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":79.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":142.63,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":149.76,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":142.63,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":142.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":145.48,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":145.48,"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":99.19,"maximum":99.19,"gross_charge":109,"discounted_cash":51.35,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":99.19,"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":57.05,"maximum":149.76,"gross_charge":109,"discounted_cash":51.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":68.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":68.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":68.67,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":57.05,"standard_charge_algorithm": "Lesser of $57.05 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":57.05,"standard_charge_algorithm": "Lesser of $57.05 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|All Other Plans","standard_charge_dollar":68.67,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":68.67,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":99.19,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":142.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":79.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":142.63,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":149.76,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":142.63,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":142.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":145.48,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":145.48,"methodology":"fee schedule"}]}]},{"description":"CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITH MCC","code_information":[{"code":"025","type":"MS-DRG"}],"standard_charges":[{"minimum":27192.77,"maximum":67339,"setting":"inpatient","payers_information":[{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":67339,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":60215,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":63608.78,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":55969,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":66181,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":61047,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":27192.77,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":31724.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":30214.18,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":30818.47,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":30818.47,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":30818.47,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":32758.53,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":31963.42,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":31804.39,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":33394.61,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":32599.5,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":31804.39,"methodology":"case rate"}]}]},{"description":"CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITH CC","code_information":[{"code":"026","type":"MS-DRG"}],"standard_charges":[{"minimum":18689.72,"maximum":46053,"setting":"inpatient","payers_information":[{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":46053,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":41181,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":43718.62,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":38277,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":45261,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":41750,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":18689.72,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":21804.67,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":20766.35,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":21181.68,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":21181.68,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":21181.68,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":22515.09,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":21968.61,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":21859.31,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":22952.28,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":22405.8,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":21859.31,"methodology":"case rate"}]}]},{"description":"CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITHOUT CC/MCC","code_information":[{"code":"027","type":"MS-DRG"}],"standard_charges":[{"minimum":15136.21,"maximum":37158,"setting":"inpatient","payers_information":[{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":37158,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":33226,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":35406.32,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":30883,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":36519,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":33685,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":15136.21,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":17658.92,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":16818.01,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":17154.38,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":17154.38,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":17154.38,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":18234.26,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":17791.68,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":17703.16,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":18588.32,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":18145.74,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":17703.16,"methodology":"case rate"}]}]},{"description":"HC PERC LAMINO-/LAMINECTOMY INDIR IMAG GUIDE LUMBAR","code_information":[{"code":"0275T","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":8145.41,"maximum":8145.41,"gross_charge":8951,"discounted_cash":4216.67,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":8145.41,"methodology":"fee schedule"}]}]},{"description":"HC PERC LAMINO-/LAMINECTOMY INDIR IMAG GUIDE LUMBAR","code_information":[{"code":"0275T","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":2102.59,"maximum":14037.14,"gross_charge":8951,"discounted_cash":4216.67,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5639.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5639.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5639.13,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":14037.14,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5639.13,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":5639.13,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":4266.22,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":8145.41,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4296.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":6713.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":2416.77,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":2537.61,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":2368.44,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":2102.59,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2465.11,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2489.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":7229.13,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":7369.5,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7299.31,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"}]}]},{"description":"SPINAL PROCEDURES WITH MCC","code_information":[{"code":"028","type":"MS-DRG"}],"standard_charges":[{"minimum":36859.67,"maximum":91539,"setting":"inpatient","payers_information":[{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":91539,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":81854,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":86221.42,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":76082,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":89964,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":82985,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":36859.67,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":43002.94,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":40955.18,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":41774.29,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":41774.29,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":41774.29,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":44404.04,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":43326.27,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":43110.71,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":45266.25,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":44188.48,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":43110.71,"methodology":"case rate"}]}]},{"description":"SPINAL PROCEDURES WITH CC OR SPINAL NEUROSTIMULATORS","code_information":[{"code":"029","type":"MS-DRG"}],"standard_charges":[{"minimum":20482.72,"maximum":50542,"setting":"inpatient","payers_information":[{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":50542,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":45195,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":47912.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":42008,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":49672,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":45819,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":20482.72,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":23896.5,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":22758.57,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":23213.75,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":23213.75,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":23213.75,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":24675.08,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":24076.17,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":23956.38,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":25154.2,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":24555.29,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":23956.38,"methodology":"case rate"}]}]},{"description":"SPINAL PROCEDURES WITHOUT CC/MCC","code_information":[{"code":"030","type":"MS-DRG"}],"standard_charges":[{"minimum":13678.23,"maximum":33508,"setting":"inpatient","payers_information":[{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":33508,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":29963,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":31995.84,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":27850,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":32931,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":30377,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":13678.23,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":15957.94,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":15198.03,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":15502,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":15502,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":15502,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":16477.86,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":16077.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":15997.92,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":16797.82,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":16397.87,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":15997.92,"methodology":"case rate"}]}]},{"description":"VENTRICULAR SHUNT PROCEDURES WITH MCC","code_information":[{"code":"031","type":"MS-DRG"}],"standard_charges":[{"minimum":25498.41,"maximum":63098,"setting":"inpatient","payers_information":[{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":63098,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":56422,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":59645.38,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":52443,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":62012,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":57202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":25498.41,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":29748.14,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":28331.56,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":28898.2,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":28898.2,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":28898.2,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":30717.38,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":29971.81,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":29822.69,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":31313.83,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":30568.26,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":29822.69,"methodology":"case rate"}]}]},{"description":"VENTRICULAR SHUNT PROCEDURES WITH CC","code_information":[{"code":"032","type":"MS-DRG"}],"standard_charges":[{"minimum":13138.11,"maximum":32156,"setting":"inpatient","payers_information":[{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":32156,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":28754,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":30732.4,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":26726,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":31603,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":29151,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":13138.11,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":15327.79,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":14597.89,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":14889.85,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":14889.85,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":14889.85,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":15827.19,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":15443.04,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":15366.2,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":16134.51,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":15750.36,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":15366.2,"methodology":"case rate"}]}]},{"description":"VENTRICULAR SHUNT PROCEDURES WITHOUT CC/MCC","code_information":[{"code":"033","type":"MS-DRG"}],"standard_charges":[{"minimum":9889.55,"maximum":24023,"setting":"inpatient","payers_information":[{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":24023,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":21482,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":23133.42,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":19967,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":23610,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":21779,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":9889.55,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":11537.8,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":10988.38,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":11208.15,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":11208.15,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11208.15,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":11913.72,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":11624.55,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":11566.71,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":12145.05,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":11855.88,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":11566.71,"methodology":"case rate"}]}]},{"description":"CAROTID ARTERY STENT PROCEDURES WITH MCC","code_information":[{"code":"034","type":"MS-DRG"}],"standard_charges":[{"minimum":23682.56,"maximum":58552,"setting":"inpatient","payers_information":[{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":58552,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":52357,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":55397.78,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":48665,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":57545,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":53081,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":23682.56,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":27629.65,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":26313.95,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":26840.23,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":26840.23,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":26840.23,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":28529.86,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":27837.39,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":27698.89,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":29083.84,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":28391.37,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":27698.89,"methodology":"case rate"}]}]},{"description":"CAROTID ARTERY STENT PROCEDURES WITH CC","code_information":[{"code":"035","type":"MS-DRG"}],"standard_charges":[{"minimum":13975.36,"maximum":34252,"setting":"inpatient","payers_information":[{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":34252,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":30628,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":32690.88,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":28468,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":33662,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":31051,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":13975.36,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":16304.58,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":15528.17,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":15838.74,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":15838.74,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":15838.74,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":16835.81,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":16427.17,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":16345.44,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":17162.72,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":16754.08,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":16345.44,"methodology":"case rate"}]}]},{"description":"CAROTID ARTERY STENT PROCEDURES WITHOUT CC/MCC","code_information":[{"code":"036","type":"MS-DRG"}],"standard_charges":[{"minimum":11318.66,"maximum":27601,"setting":"inpatient","payers_information":[{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":27601,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":24681,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":26476.36,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":22940,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":27126,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":25022,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":11318.66,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":13205.1,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":12576.28,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":12827.81,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":12827.81,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12827.81,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":13635.33,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":13304.38,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":13238.18,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":13900.09,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":13569.14,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":13238.18,"methodology":"case rate"}]}]},{"description":"EXTRACRANIAL PROCEDURES WITH MCC","code_information":[{"code":"037","type":"MS-DRG"}],"standard_charges":[{"minimum":20267.39,"maximum":50003,"setting":"inpatient","payers_information":[{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":50003,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":44713,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":47409.08,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":41560,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":49143,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":45330,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":20267.39,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":23645.29,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":22519.32,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":22969.71,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":22969.71,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":22969.71,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":24415.68,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":23823.07,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":23704.54,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":24889.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":24297.16,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":23704.54,"methodology":"case rate"}]}]},{"description":"EXTRACRANIAL PROCEDURES WITH CC","code_information":[{"code":"038","type":"MS-DRG"}],"standard_charges":[{"minimum":9984.58,"maximum":24261,"setting":"inpatient","payers_information":[{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":24261,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":21695,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":23355.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":20165,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":23844,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":21994,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":9984.58,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":11648.67,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":11093.97,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":11315.85,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":11315.85,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11315.85,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":12028.2,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":11736.25,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":11677.86,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":12261.76,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":11969.81,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":11677.86,"methodology":"case rate"}]}]},{"description":"EXTRACRANIAL PROCEDURES WITHOUT CC/MCC","code_information":[{"code":"039","type":"MS-DRG"}],"standard_charges":[{"minimum":7139,"maximum":17138,"setting":"inpatient","payers_information":[{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":17138,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":15325,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":16699.4,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":14244,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16843,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":15536,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":7139,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":8328.84,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":7932.22,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":8090.87,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":8090.87,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":8090.87,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":8600.2,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":8391.45,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":8349.7,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":8767.19,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":8558.45,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":8349.7,"methodology":"case rate"}]}]},{"description":"PERIPHERAL CRANIAL NERVE AND OTHER NERVOUS SYSTEM PROCEDURES WITH MCC","code_information":[{"code":"040","type":"MS-DRG"}],"standard_charges":[{"minimum":22981.23,"maximum":56797,"setting":"inpatient","payers_information":[{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":56797,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":50788,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":53757.26,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":47206,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":55820,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":51489,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":22981.23,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":26811.44,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":25534.7,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":26045.4,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":26045.4,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":26045.4,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":27684.99,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":27013.03,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":26878.63,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":28222.57,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":27550.6,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":26878.63,"methodology":"case rate"}]}]},{"description":"HC INSJ/RPLC CARDIAC MODULIJ SYS","code_information":[{"code":"0408T","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":55721.12,"maximum":55721.12,"gross_charge":61232,"discounted_cash":28845.36,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":55721.12,"methodology":"fee schedule"}]}]},{"description":"HC INSJ/RPLC CARDIAC MODULIJ SYS","code_information":[{"code":"0408T","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":5385.62,"maximum":62999.72,"gross_charge":61232,"discounted_cash":28845.36,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":38576.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":38576.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":38576.16,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":62999.72,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":38576.16,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":38576.16,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":5385.62,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":55721.12,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":29391.36,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":45924,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":16532.64,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":17359.28,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":16201.99,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":14383.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":16863.3,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":17028.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":32444.86,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":31499.86,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":31499.86,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":33074.85,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":32759.85,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":31499.86,"methodology":"case rate"}]}]},{"description":"HC INSJ/RPLC CAR MODULJ PLS GN","code_information":[{"code":"0409T","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":55721.12,"maximum":55721.12,"gross_charge":61232,"discounted_cash":28845.36,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":55721.12,"methodology":"fee schedule"}]}]},{"description":"HC INSJ/RPLC CAR MODULJ PLS GN","code_information":[{"code":"0409T","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":5385.62,"maximum":55721.12,"gross_charge":61232,"discounted_cash":28845.36,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":38576.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":38576.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":38576.16,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":44105.86,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":38576.16,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":38576.16,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":5385.62,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":55721.12,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":29391.36,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":45924,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":16532.64,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":17359.28,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":16201.99,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":14383.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":16863.3,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":17028.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":22714.52,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":22052.93,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":22052.93,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":23155.58,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":22935.05,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":22052.93,"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":13875.51,"maximum":34002,"setting":"inpatient","payers_information":[{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":34002,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":30404,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":32457.32,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":28260,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":33417,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":30824,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":13875.51,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":16188.1,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":15417.23,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":15725.58,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":15725.58,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":15725.58,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":16715.52,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":16309.81,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":16228.66,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":17040.1,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":16634.38,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":16228.66,"methodology":"case rate"}]}]},{"description":"HC INSJ/RPLC CAR MODULJ ATR ELT","code_information":[{"code":"0410T","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":19714.24,"maximum":19714.24,"gross_charge":21664,"discounted_cash":10205.55,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":19714.24,"methodology":"fee schedule"}]}]},{"description":"HC INSJ/RPLC CAR MODULJ ATR ELT","code_information":[{"code":"0410T","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":5088.88,"maximum":19714.24,"gross_charge":21664,"discounted_cash":10205.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13648.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":13648.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":13648.32,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":16261.96,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13648.32,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":13648.32,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":5385.62,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":19714.24,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10398.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":16248,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":5849.28,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":6141.75,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":5732.3,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":5088.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":5966.27,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6024.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":8374.91,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":8130.98,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":8130.98,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":8537.53,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":8456.22,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":8130.98,"methodology":"case rate"}]}]},{"description":"HC INSJ/RPLC CAR MODULJ VNT ELT","code_information":[{"code":"0411T","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":19714.24,"maximum":19714.24,"gross_charge":21664,"discounted_cash":10205.55,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":19714.24,"methodology":"fee schedule"}]}]},{"description":"HC INSJ/RPLC CAR MODULJ VNT ELT","code_information":[{"code":"0411T","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":5088.88,"maximum":19714.24,"gross_charge":21664,"discounted_cash":10205.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13648.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":13648.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":13648.32,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":16261.96,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13648.32,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":13648.32,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":5385.62,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":19714.24,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10398.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":16248,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":5849.28,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":6141.75,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":5732.3,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":5088.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":5966.27,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6024.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":8374.91,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":8130.98,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":8130.98,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":8537.53,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":8456.22,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":8130.98,"methodology":"case rate"}]}]},{"description":"HC MVL CARDIAC MODULJ PLS GEN","code_information":[{"code":"0412T","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":8321.04,"maximum":8321.04,"gross_charge":9144,"discounted_cash":4307.59,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":8321.04,"methodology":"fee schedule"}]}]},{"description":"HC MVL CARDIAC MODULJ PLS GEN","code_information":[{"code":"0412T","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":2147.93,"maximum":8321.04,"gross_charge":9144,"discounted_cash":4307.59,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5760.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5760.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5760.72,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":7151.08,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5760.72,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":5760.72,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2657.78,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":8321.04,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4389.12,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":6858,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":2468.88,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":2592.33,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":2419.51,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":2147.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2518.26,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2542.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3682.81,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":3575.54,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3575.54,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":3754.32,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3718.56,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":3575.54,"methodology":"case rate"}]}]},{"description":"HC RMVL CAR MODULJ TRANVNS ELT","code_information":[{"code":"0413T","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":8321.04,"maximum":8321.04,"gross_charge":9144,"discounted_cash":4307.59,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":8321.04,"methodology":"fee schedule"}]}]},{"description":"HC RMVL CAR MODULJ TRANVNS ELT","code_information":[{"code":"0413T","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":2147.93,"maximum":8321.04,"gross_charge":9144,"discounted_cash":4307.59,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5760.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5760.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5760.72,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":7151.08,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5760.72,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":5760.72,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2657.78,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":8321.04,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4389.12,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":6858,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":2468.88,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":2592.33,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":2419.51,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":2147.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2518.26,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2542.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3682.81,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":3575.54,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3575.54,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":3754.32,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3718.56,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":3575.54,"methodology":"case rate"}]}]},{"description":"HC RMVL & RPL CAR MODULJ PLS GN","code_information":[{"code":"0414T","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":55721.12,"maximum":55721.12,"gross_charge":61232,"discounted_cash":28845.36,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":55721.12,"methodology":"fee schedule"}]}]},{"description":"HC RMVL & RPL CAR MODULJ PLS GN","code_information":[{"code":"0414T","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":5385.62,"maximum":55721.12,"gross_charge":61232,"discounted_cash":28845.36,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":38576.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":38576.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":38576.16,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":44105.86,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":38576.16,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":38576.16,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":5385.62,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":55721.12,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":29391.36,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":45924,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":16532.64,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":17359.28,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":16201.99,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":14383.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":16863.3,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":17028.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":22714.52,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":22052.93,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":22052.93,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":23155.58,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":22935.05,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":22052.93,"methodology":"case rate"}]}]},{"description":"HC REPOS CAR MODULJ TRANVNS ELT","code_information":[{"code":"0415T","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":1305.85,"maximum":1305.85,"gross_charge":1435,"discounted_cash":676.01,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1305.85,"methodology":"fee schedule"}]}]},{"description":"HC REPOS CAR MODULJ TRANVNS ELT","code_information":[{"code":"0415T","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":337.09,"maximum":1538.38,"gross_charge":1435,"discounted_cash":676.01,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":904.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":904.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":904.05,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":1214.86,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":904.05,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":904.05,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1305.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":688.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":1076.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":387.45,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":406.83,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":379.71,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":337.09,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":395.2,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":399.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":625.65,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":607.43,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":607.43,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":637.8,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":631.73,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":607.43,"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":10864.53,"maximum":26464,"setting":"inpatient","payers_information":[{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":26464,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":23664,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":25414.1,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":21996,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":26009,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":23991,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":10864.53,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":12675.29,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":12071.7,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":12313.14,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":12313.14,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12313.14,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":13088.27,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":12770.59,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":12707.05,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":13342.41,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":13024.73,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":12707.05,"methodology":"case rate"}]}]},{"description":"SPINAL DISORDERS AND INJURIES WITH CC/MCC","code_information":[{"code":"052","type":"MS-DRG"}],"standard_charges":[{"minimum":12397.69,"maximum":30302,"setting":"inpatient","payers_information":[{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":30302,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":27096,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":29000.44,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":25186,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":29781,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":27471,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":12397.69,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":14463.98,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":13775.21,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":14050.72,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":14050.72,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":14050.72,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":14935.23,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":14572.73,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":14500.22,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":15225.24,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":14862.73,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":14500.22,"methodology":"case rate"}]}]},{"description":"LRT IAD 18BCT/8VIR&7ARG RNA","code_information":[{"code":"0528U","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":515.97,"maximum":515.97,"gross_charge":567,"discounted_cash":267.11,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":515.97,"methodology":"fee schedule"}]}]},{"description":"LRT IAD 18BCT/8VIR&7ARG RNA","code_information":[{"code":"0528U","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":133.19,"maximum":515.97,"gross_charge":567,"discounted_cash":267.11,"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":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":300.51,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":266.49,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":357.21,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":357.21,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":515.97,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":413.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":153.09,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":160.75,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":150.03,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":133.19,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":156.16,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":157.69,"methodology":"fee schedule"}]}]},{"description":"SPINAL DISORDERS AND INJURIES WITHOUT CC/MCC","code_information":[{"code":"053","type":"MS-DRG"}],"standard_charges":[{"minimum":5835.01,"maximum":13874,"setting":"inpatient","payers_information":[{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":13874,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":12406,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":13649.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":11531,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13635,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":12577,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":5835.01,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":6807.51,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":6483.34,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":6613.01,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":6613.01,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6613.01,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":7029.3,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":6858.69,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6824.56,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":7165.79,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6995.18,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":6824.56,"methodology":"case rate"}]}]},{"description":"NERVOUS SYSTEM NEOPLASMS WITH MCC","code_information":[{"code":"054","type":"MS-DRG"}],"standard_charges":[{"minimum":9309.73,"maximum":22572,"setting":"inpatient","payers_information":[{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":22572,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":20184,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":21777.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":18761,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":22184,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":20463,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":9309.73,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":10861.35,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":10344.14,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":10551.03,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":10551.03,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":10551.03,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":11215.22,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":10943.01,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":10888.56,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":11432.99,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":11160.78,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":10888.56,"methodology":"case rate"}]}]},{"description":"NERVOUS SYSTEM NEOPLASMS WITHOUT MCC","code_information":[{"code":"055","type":"MS-DRG"}],"standard_charges":[{"minimum":6855.11,"maximum":16427,"setting":"inpatient","payers_information":[{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":16427,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":14689,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":16035.32,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":13653,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16145,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":14892,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":6855.11,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":7997.62,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":7616.78,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":7769.12,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":7769.12,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":7769.12,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":8258.19,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":8057.75,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":8017.66,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":8418.55,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":8218.11,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":8017.66,"methodology":"case rate"}]}]},{"description":"DEGENERATIVE NERVOUS SYSTEM DISORDERS WITH MCC","code_information":[{"code":"056","type":"MS-DRG"}],"standard_charges":[{"minimum":15354.54,"maximum":37704,"setting":"inpatient","payers_information":[{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":37704,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":33715,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":35917.04,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":31338,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":37056,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":34181,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":15354.54,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":17913.63,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":17060.6,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":17401.82,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":17401.82,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":17401.82,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":18497.28,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":18048.32,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":17958.52,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":18856.45,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":18407.49,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":17958.52,"methodology":"case rate"}]}]},{"description":"DEGENERATIVE NERVOUS SYSTEM DISORDERS WITHOUT MCC","code_information":[{"code":"057","type":"MS-DRG"}],"standard_charges":[{"minimum":8319.1,"maximum":20092,"setting":"inpatient","payers_information":[{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":20092,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":17966,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":19459.86,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":16699,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":19746,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":18215,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":8319.1,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":9705.62,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":9243.44,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":9428.31,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":9428.31,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":9428.31,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":10021.83,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":9778.58,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":9729.93,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":10216.43,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":9973.18,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":9729.93,"methodology":"case rate"}]}]},{"description":"MULTIPLE SCLEROSIS AND CEREBELLAR ATAXIA WITH MCC","code_information":[{"code":"058","type":"MS-DRG"}],"standard_charges":[{"minimum":11395.63,"maximum":27794,"setting":"inpatient","payers_information":[{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":27794,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":24853,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":26656.44,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":23101,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":27316,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":25197,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":11395.63,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":13294.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":12661.81,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":12915.05,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":12915.05,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12915.05,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":13728.07,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":13394.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":13328.22,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":13994.64,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":13661.43,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":13328.22,"methodology":"case rate"}]}]},{"description":"MULTIPLE SCLEROSIS AND CEREBELLAR ATAXIA WITH CC","code_information":[{"code":"059","type":"MS-DRG"}],"standard_charges":[{"minimum":7652.66,"maximum":18424,"setting":"inpatient","payers_information":[{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":18424,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":16475,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":17900.94,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":15313,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":18107,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":16702,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":7652.66,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":8928.1,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":8502.95,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":8673.01,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":8673.01,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":8673.01,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":9218.99,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":8995.23,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":8950.47,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":9398,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":9174.24,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":8950.47,"methodology":"case rate"}]}]},{"description":"MULTIPLE SCLEROSIS AND CEREBELLAR ATAXIA WITHOUT CC/MCC","code_information":[{"code":"060","type":"MS-DRG"}],"standard_charges":[{"minimum":5660.58,"maximum":13437,"setting":"inpatient","payers_information":[{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":13437,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":12015,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":13241.1,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":11168,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13206,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":12181,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":5660.58,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":6604.01,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":6289.53,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":6415.33,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":6415.33,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6415.33,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6819.17,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":6653.66,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6620.55,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":6951.58,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6786.07,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":6620.55,"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":16553.28,"maximum":40705,"setting":"inpatient","payers_information":[{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":40705,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":36399,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":38721.1,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":33832,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":40005,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":36901,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":16553.28,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":19312.16,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":18392.53,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":18760.39,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":18760.39,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":18760.39,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":19941.37,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":19457.36,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":19360.55,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":20328.58,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":19844.57,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":19360.55,"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":11004.68,"maximum":26815,"setting":"inpatient","payers_information":[{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":26815,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":23978,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":25741.92,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":22287,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":26354,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":24309,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":11004.68,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":12838.8,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":12227.42,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":12471.97,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":12471.97,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12471.97,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":13257.09,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":12935.32,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":12870.96,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":13514.51,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":13192.74,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":12870.96,"methodology":"case rate"}]}]},{"description":"HC EVASC VEN ARTLZ TIBL/PRNL VN","code_information":[{"code":"0620T","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":38771.46,"maximum":38771.46,"gross_charge":42606,"discounted_cash":20070.97,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":38771.46,"methodology":"fee schedule"}]}]},{"description":"HC EVASC VEN ARTLZ TIBL/PRNL VN","code_information":[{"code":"0620T","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":5385.62,"maximum":68774.58,"gross_charge":42606,"discounted_cash":20070.97,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":26841.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":26841.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":26841.78,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":68774.58,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":26841.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":26841.78,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":5385.62,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":38771.46,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":20450.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":31954.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":11503.62,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":12078.81,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":11273.55,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":10008.15,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":11733.7,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11848.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":35418.91,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":34387.29,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":34387.29,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":36106.65,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":35762.78,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":34387.29,"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":8742.53,"maximum":21152,"setting":"inpatient","payers_information":[{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":21152,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":18914,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":20450.34,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":17580,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":20788,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":19176,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":8742.53,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":10199.62,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":9713.92,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":9908.2,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":9908.2,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":9908.2,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":10531.93,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":10276.3,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":10225.17,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":10736.43,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":10480.8,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":10225.17,"methodology":"case rate"}]}]},{"description":"INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH MCC","code_information":[{"code":"064","type":"MS-DRG"}],"standard_charges":[{"minimum":12257.55,"maximum":29951,"setting":"inpatient","payers_information":[{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":29951,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":26783,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":28672.62,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":24894,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":29436,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":27153,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":12257.55,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":14300.48,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":13619.5,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":13891.89,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":13891.89,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13891.89,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":14766.4,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":14408,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":14336.31,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":15053.13,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":14694.72,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":14336.31,"methodology":"case rate"}]}]},{"description":"HC TCAT RMVL/DBLK ICAR MAS PERQ","code_information":[{"code":"0644T","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":11405.94,"maximum":11405.94,"gross_charge":12534,"discounted_cash":5904.56,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":11405.94,"methodology":"fee schedule"}]}]},{"description":"HC TCAT RMVL/DBLK ICAR MAS PERQ","code_information":[{"code":"0644T","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":2944.24,"maximum":11405.94,"gross_charge":12534,"discounted_cash":5904.56,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7896.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":7896.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":7896.42,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7896.42,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":7896.42,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":11405.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":3384.18,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":3553.39,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":3316.5,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":2944.24,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3451.87,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3485.71,"methodology":"fee schedule"}]}]},{"description":"INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH CC OR TPA IN 24 HOURS","code_information":[{"code":"065","type":"MS-DRG"}],"standard_charges":[{"minimum":6409.42,"maximum":15311,"setting":"inpatient","payers_information":[{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":15311,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":13692,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":14992.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":12726,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15048,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":13881,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":6409.42,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":7477.65,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":7121.57,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":7264.01,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":7264.01,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":7264.01,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":7721.28,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":7533.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7496.38,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":7871.2,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7683.79,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":7496.38,"methodology":"case rate"}]}]},{"description":"INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITHOUT CC/MCC","code_information":[{"code":"066","type":"MS-DRG"}],"standard_charges":[{"minimum":4432.97,"maximum":10369.5,"setting":"inpatient","payers_information":[{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":10364,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":9267,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":10369.5,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":8614,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10185,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":9395,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":4432.97,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":5171.8,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":4925.52,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":5024.04,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":5024.04,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5024.04,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5340.3,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":5210.68,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5184.75,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":5443.99,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":5314.37,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":5184.75,"methodology":"case rate"}]}]},{"description":"NONSPECIFIC CVA AND PRECEREBRAL OCCLUSION WITHOUT INFARCTION WITH MCC","code_information":[{"code":"067","type":"MS-DRG"}],"standard_charges":[{"minimum":9043.87,"maximum":21906,"setting":"inpatient","payers_information":[{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":21906,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":19589,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":21155.24,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":18207,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":21530,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":19859,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":9043.87,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":10551.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":10048.74,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":10249.72,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":10249.72,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":10249.72,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":10894.95,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":10630.51,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":10577.62,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":11106.51,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":10842.07,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":10577.62,"methodology":"case rate"}]}]},{"description":"NONSPECIFIC CVA AND PRECEREBRAL OCCLUSION WITHOUT INFARCTION WITHOUT MCC","code_information":[{"code":"068","type":"MS-DRG"}],"standard_charges":[{"minimum":5595.02,"maximum":13273,"setting":"inpatient","payers_information":[{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":13273,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":11869,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":13087.74,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":11032,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13044,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":12032,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":5595.02,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":6527.52,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":6216.68,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":6341.02,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":6341.02,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6341.02,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6740.19,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":6576.59,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6543.87,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":6871.07,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6707.47,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":6543.87,"methodology":"case rate"}]}]},{"description":"TRANSIENT ISCHEMIA WITHOUT THROMBOLYTIC","code_information":[{"code":"069","type":"MS-DRG"}],"standard_charges":[{"minimum":5105.42,"maximum":12047,"setting":"inpatient","payers_information":[{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":12047,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":10773,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":11942.48,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":10013,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11840,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":10921,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":5105.42,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":5956.32,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":5672.68,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":5786.14,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":5786.14,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5786.14,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6150.38,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":6001.1,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5971.24,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":6269.81,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6120.53,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":5971.24,"methodology":"case rate"}]}]},{"description":"NONSPECIFIC CEREBROVASCULAR DISORDERS WITH MCC","code_information":[{"code":"070","type":"MS-DRG"}],"standard_charges":[{"minimum":10751.46,"maximum":26181,"setting":"inpatient","payers_information":[{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":26181,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":23411,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":25149.58,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":21760,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":25731,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":23735,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":10751.46,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":12543.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":11946.06,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":12184.99,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":12184.99,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12184.99,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":12952.04,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":12637.67,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":12574.79,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":13203.53,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":12889.16,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":12574.79,"methodology":"case rate"}]}]},{"description":"NONSPECIFIC CEREBROVASCULAR DISORDERS WITH CC","code_information":[{"code":"071","type":"MS-DRG"}],"standard_charges":[{"minimum":6631.96,"maximum":15869,"setting":"inpatient","payers_information":[{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":15869,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":14190,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":15513.34,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":13189,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15596,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":14386,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":6631.96,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":7737.29,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":7368.84,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":7516.22,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":7516.22,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":7516.22,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":7989.38,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":7795.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7756.67,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":8144.51,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7950.59,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":7756.67,"methodology":"case rate"}]}]},{"description":"NONSPECIFIC CEREBROVASCULAR DISORDERS WITHOUT CC/MCC","code_information":[{"code":"072","type":"MS-DRG"}],"standard_charges":[{"minimum":4805.28,"maximum":11296,"setting":"inpatient","payers_information":[{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":11296,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":10101,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":11240.4,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":9388,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11101,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":10240,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":4805.28,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":5606.15,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":5339.19,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":5445.98,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":5445.98,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5445.98,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5788.81,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":5648.31,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5620.2,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":5901.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":5760.71,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":5620.2,"methodology":"case rate"}]}]},{"description":"CRANIAL AND PERIPHERAL NERVE DISORDERS WITH MCC","code_information":[{"code":"073","type":"MS-DRG"}],"standard_charges":[{"minimum":9589.41,"maximum":23272,"setting":"inpatient","payers_information":[{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":23272,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":20810,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":22431.34,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":19342,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":22872,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":21097,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":9589.41,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":11187.64,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":10654.89,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":10867.99,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":10867.99,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":10867.99,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":11552.15,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":11271.75,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":11215.67,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":11776.46,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":11496.07,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":11215.67,"methodology":"case rate"}]}]},{"description":"CRANIAL AND PERIPHERAL NERVE DISORDERS WITHOUT MCC","code_information":[{"code":"074","type":"MS-DRG"}],"standard_charges":[{"minimum":6562.8,"maximum":15695,"setting":"inpatient","payers_information":[{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":15695,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":14035,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":15351.54,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":13045,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15425,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":14229,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":6562.8,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":7656.59,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":7291.99,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":7437.83,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":7437.83,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":7437.83,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":7906.05,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":7714.15,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7675.77,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":8059.56,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7867.67,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":7675.77,"methodology":"case rate"}]}]},{"description":"VIRAL MENINGITIS WITH CC/MCC","code_information":[{"code":"075","type":"MS-DRG"}],"standard_charges":[{"minimum":10652.81,"maximum":25934,"setting":"inpatient","payers_information":[{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":25934,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":23190,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":24918.84,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":21555,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":25488,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":23511,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":10652.81,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":12428.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":11836.45,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":12073.18,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":12073.18,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12073.18,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":12833.21,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":12521.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":12459.42,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":13082.4,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":12770.91,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":12459.42,"methodology":"case rate"}]}]},{"description":"VIRAL MENINGITIS WITHOUT CC/MCC","code_information":[{"code":"076","type":"MS-DRG"}],"standard_charges":[{"minimum":5807.94,"maximum":13806,"setting":"inpatient","payers_information":[{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":13806,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":12345,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":13585.8,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":11475,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13568,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":12516,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":5807.94,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":6775.93,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":6453.26,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":6582.33,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":6582.33,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6582.33,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6996.69,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":6826.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6792.9,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":7132.55,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6962.73,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":6792.9,"methodology":"case rate"}]}]},{"description":"HYPERTENSIVE ENCEPHALOPATHY WITH MCC","code_information":[{"code":"077","type":"MS-DRG"}],"standard_charges":[{"minimum":9593.62,"maximum":23283,"setting":"inpatient","payers_information":[{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":23283,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":20819,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":22441.2,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":19351,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":22882,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":21107,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":9593.62,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":11192.55,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":10659.57,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":10872.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":10872.77,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":10872.77,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":11557.22,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":11276.71,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":11220.6,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":11781.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":11501.12,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":11220.6,"methodology":"case rate"}]}]},{"description":"HYPERTENSIVE ENCEPHALOPATHY WITH CC","code_information":[{"code":"078","type":"MS-DRG"}],"standard_charges":[{"minimum":6295.14,"maximum":15025,"setting":"inpatient","payers_information":[{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":15025,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":13436,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":14725.44,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":12488,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14767,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":13621,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":6295.14,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":7344.32,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":6994.59,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":7134.49,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":7134.49,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":7134.49,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":7583.61,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":7399.54,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7362.72,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":7730.86,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7546.79,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":7362.72,"methodology":"case rate"}]}]},{"description":"INSTLJ FECAL MICROBIOTA SSP","code_information":[{"code":"0780T","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":272.09,"maximum":272.09,"gross_charge":299,"discounted_cash":140.86,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":272.09,"methodology":"fee schedule"}]}]},{"description":"INSTLJ FECAL MICROBIOTA SSP","code_information":[{"code":"0780T","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":70.24,"maximum":272.09,"gross_charge":299,"discounted_cash":140.86,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":188.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":188.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":188.37,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":188.37,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":188.37,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":272.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":80.73,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":84.77,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":79.12,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":70.24,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":82.35,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":83.16,"methodology":"fee schedule"}]}]},{"description":"HYPERTENSIVE ENCEPHALOPATHY WITHOUT CC/MCC","code_information":[{"code":"079","type":"MS-DRG"}],"standard_charges":[{"minimum":4303.05,"maximum":10065.6,"setting":"inpatient","payers_information":[{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":10039,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":8976,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":10065.6,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":8343,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9866,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":9100,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":4303.05,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":5020.22,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":4781.16,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":4876.79,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":4876.79,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4876.79,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5183.79,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":5057.97,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5032.8,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":5284.44,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":5158.62,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":5032.8,"methodology":"case rate"}]}]},{"description":"TCAT INS 2CHMBR LDLS PM CMPL","code_information":[{"code":"0795T","type":"CPT"},{"code":"0480","type":"RC"}],"standard_charges":[{"minimum":43548.96,"maximum":43548.96,"gross_charge":47856,"discounted_cash":22544.15,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":43548.96,"methodology":"fee schedule"}]}]},{"description":"TCAT INS 2CHMBR LDLS PM CMPL","code_information":[{"code":"0795T","type":"CPT"},{"code":"0480","type":"RC"}],"standard_charges":[{"minimum":11241.38,"maximum":43548.96,"gross_charge":47856,"discounted_cash":22544.15,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":30149.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":30149.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":30149.28,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":30149.28,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":30149.28,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":43548.96,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":29670.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":34934.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":12921.12,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":13567.18,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":12662.7,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":11241.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":13179.55,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13308.76,"methodology":"fee schedule"}]}]},{"description":"TCAT INS 2CHMBR LDLS PM RA","code_information":[{"code":"0796T","type":"CPT"},{"code":"0480","type":"RC"}],"standard_charges":[{"minimum":43548.96,"maximum":43548.96,"gross_charge":47856,"discounted_cash":22544.15,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":43548.96,"methodology":"fee schedule"}]}]},{"description":"TCAT INS 2CHMBR LDLS PM RA","code_information":[{"code":"0796T","type":"CPT"},{"code":"0480","type":"RC"}],"standard_charges":[{"minimum":11241.38,"maximum":43548.96,"gross_charge":47856,"discounted_cash":22544.15,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":30149.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":30149.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":30149.28,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":30149.28,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":30149.28,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":43548.96,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":29670.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":34934.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":12921.12,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":13567.18,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":12662.7,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":11241.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":13179.55,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13308.76,"methodology":"fee schedule"}]}]},{"description":"TCAT INS 2CHMBR LDLS PM RV","code_information":[{"code":"0797T","type":"CPT"},{"code":"0480","type":"RC"}],"standard_charges":[{"minimum":43548.96,"maximum":43548.96,"gross_charge":47856,"discounted_cash":22544.15,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":43548.96,"methodology":"fee schedule"}]}]},{"description":"TCAT INS 2CHMBR LDLS PM RV","code_information":[{"code":"0797T","type":"CPT"},{"code":"0480","type":"RC"}],"standard_charges":[{"minimum":11241.38,"maximum":43548.96,"gross_charge":47856,"discounted_cash":22544.15,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":30149.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":30149.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":30149.28,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":30149.28,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":30149.28,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":43548.96,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":29670.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":34934.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":12921.12,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":13567.18,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":12662.7,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":11241.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":13179.55,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13308.76,"methodology":"fee schedule"}]}]},{"description":"TCAT RMV 2CHMBR LDLS PM CMPL","code_information":[{"code":"0798T","type":"CPT"},{"code":"0480","type":"RC"}],"standard_charges":[{"minimum":7123.48,"maximum":7123.48,"gross_charge":7828,"discounted_cash":3687.64,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":7123.48,"methodology":"fee schedule"}]}]},{"description":"TCAT RMV 2CHMBR LDLS PM CMPL","code_information":[{"code":"0798T","type":"CPT"},{"code":"0480","type":"RC"}],"standard_charges":[{"minimum":1838.8,"maximum":7123.48,"gross_charge":7828,"discounted_cash":3687.64,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4931.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4931.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4931.64,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4931.64,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":4931.64,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":7123.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4853.36,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":5714.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":2113.56,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":2219.24,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":2071.29,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":1838.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2155.84,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2176.97,"methodology":"fee schedule"}]}]},{"description":"TCAT RMVL 2CHMBR LDLS PM RA","code_information":[{"code":"0799T","type":"CPT"},{"code":"0480","type":"RC"}],"standard_charges":[{"minimum":7123.48,"maximum":7123.48,"gross_charge":7828,"discounted_cash":3687.64,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":7123.48,"methodology":"fee schedule"}]}]},{"description":"TCAT RMVL 2CHMBR LDLS PM RA","code_information":[{"code":"0799T","type":"CPT"},{"code":"0480","type":"RC"}],"standard_charges":[{"minimum":1838.8,"maximum":7123.48,"gross_charge":7828,"discounted_cash":3687.64,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4931.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4931.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4931.64,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4931.64,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":4931.64,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":7123.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4853.36,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":5714.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":2113.56,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":2219.24,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":2071.29,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":1838.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2155.84,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2176.97,"methodology":"fee schedule"}]}]},{"description":"NONTRAUMATIC STUPOR AND COMA WITH MCC","code_information":[{"code":"080","type":"MS-DRG"}],"standard_charges":[{"minimum":12249.13,"maximum":29930,"setting":"inpatient","payers_information":[{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":29930,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":26764,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":28652.92,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":24876,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":29415,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":27133,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":12249.13,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":14290.65,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":13610.14,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":13882.35,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":13882.35,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13882.35,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":14756.26,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":14398.1,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":14326.46,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":15042.79,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":14684.63,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":14326.46,"methodology":"case rate"}]}]},{"description":"TCAT RMVL 2CHMBR LDLS PM RV","code_information":[{"code":"0800T","type":"CPT"},{"code":"0480","type":"RC"}],"standard_charges":[{"minimum":7123.48,"maximum":7123.48,"gross_charge":7828,"discounted_cash":3687.64,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":7123.48,"methodology":"fee schedule"}]}]},{"description":"TCAT RMVL 2CHMBR LDLS PM RV","code_information":[{"code":"0800T","type":"CPT"},{"code":"0480","type":"RC"}],"standard_charges":[{"minimum":1838.8,"maximum":7123.48,"gross_charge":7828,"discounted_cash":3687.64,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4931.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4931.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4931.64,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4931.64,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":4931.64,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":7123.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4853.36,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":5714.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":2113.56,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":2219.24,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":2071.29,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":1838.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2155.84,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2176.97,"methodology":"fee schedule"}]}]},{"description":"TCAT RMV&RPL 2CHMBR LDLS PM","code_information":[{"code":"0801T","type":"CPT"},{"code":"0480","type":"RC"}],"standard_charges":[{"minimum":43548.96,"maximum":43548.96,"gross_charge":47856,"discounted_cash":22544.15,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":43548.96,"methodology":"fee schedule"}]}]},{"description":"TCAT RMV&RPL 2CHMBR LDLS PM","code_information":[{"code":"0801T","type":"CPT"},{"code":"0480","type":"RC"}],"standard_charges":[{"minimum":11241.38,"maximum":43548.96,"gross_charge":47856,"discounted_cash":22544.15,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":30149.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":30149.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":30149.28,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":30149.28,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":30149.28,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":43548.96,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":29670.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":34934.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":12921.12,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":13567.18,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":12662.7,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":11241.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":13179.55,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13308.76,"methodology":"fee schedule"}]}]},{"description":"TCAT RMV&RPL2CHMB LDLS PM RA","code_information":[{"code":"0802T","type":"CPT"},{"code":"0480","type":"RC"}],"standard_charges":[{"minimum":43548.96,"maximum":43548.96,"gross_charge":47856,"discounted_cash":22544.15,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":43548.96,"methodology":"fee schedule"}]}]},{"description":"TCAT RMV&RPL2CHMB LDLS PM RA","code_information":[{"code":"0802T","type":"CPT"},{"code":"0480","type":"RC"}],"standard_charges":[{"minimum":11241.38,"maximum":43548.96,"gross_charge":47856,"discounted_cash":22544.15,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":30149.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":30149.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":30149.28,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":30149.28,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":30149.28,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":43548.96,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":29670.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":34934.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":12921.12,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":13567.18,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":12662.7,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":11241.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":13179.55,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13308.76,"methodology":"fee schedule"}]}]},{"description":"TCAT RMV&RPL2CHMB LDLS PM RV","code_information":[{"code":"0803T","type":"CPT"},{"code":"0480","type":"RC"}],"standard_charges":[{"minimum":43548.96,"maximum":43548.96,"gross_charge":47856,"discounted_cash":22544.15,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":43548.96,"methodology":"fee schedule"}]}]},{"description":"TCAT RMV&RPL2CHMB LDLS PM RV","code_information":[{"code":"0803T","type":"CPT"},{"code":"0480","type":"RC"}],"standard_charges":[{"minimum":11241.38,"maximum":43548.96,"gross_charge":47856,"discounted_cash":22544.15,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":30149.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":30149.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":30149.28,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":30149.28,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":30149.28,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":43548.96,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":29670.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":34934.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":12921.12,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":13567.18,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":12662.7,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":11241.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":13179.55,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13308.76,"methodology":"fee schedule"}]}]},{"description":"NONTRAUMATIC STUPOR AND COMA WITHOUT MCC","code_information":[{"code":"081","type":"MS-DRG"}],"standard_charges":[{"minimum":5735.16,"maximum":13624,"setting":"inpatient","payers_information":[{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":13624,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":12182,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":13415.56,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":11323,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13389,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":12351,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":5735.16,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":6691.02,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":6372.4,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":6499.85,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":6499.85,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6499.85,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6909.02,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":6741.32,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6707.78,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":7043.17,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6875.48,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":6707.78,"methodology":"case rate"}]}]},{"description":"TRAUMATIC STUPOR AND COMA >1 HOUR WITH MCC","code_information":[{"code":"082","type":"MS-DRG"}],"standard_charges":[{"minimum":14248.43,"maximum":34935,"setting":"inpatient","payers_information":[{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":34935,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":31239,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":33329.64,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":29036,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":34334,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":31671,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":14248.43,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":16623.16,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":15831.58,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":16148.22,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":16148.22,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":16148.22,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":17164.77,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":16748.15,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":16664.82,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":17498.07,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":17081.45,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":16664.82,"methodology":"case rate"}]}]},{"description":"TRAUMATIC STUPOR AND COMA >1 HOUR WITH CC","code_information":[{"code":"083","type":"MS-DRG"}],"standard_charges":[{"minimum":8655.92,"maximum":20935,"setting":"inpatient","payers_information":[{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":20935,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":18720,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":20247.74,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":17400,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":20575,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":18979,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":8655.92,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":10098.57,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":9617.68,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":9810.04,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":9810.04,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":9810.04,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":10427.59,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":10174.49,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":10123.87,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":10630.07,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":10376.97,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":10123.87,"methodology":"case rate"}]}]},{"description":"TRAUMATIC STUPOR AND COMA >1 HOUR WITHOUT CC/MCC","code_information":[{"code":"084","type":"MS-DRG"}],"standard_charges":[{"minimum":6043.71,"maximum":14396,"setting":"inpatient","payers_information":[{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":14396,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":12873,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":14137.32,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":11965,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14148,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":13051,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":6043.71,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":7051,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":6715.23,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":6849.54,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":6849.54,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6849.54,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":7280.72,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":7104.01,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7068.66,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":7422.1,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7245.38,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":7068.66,"methodology":"case rate"}]}]},{"description":"TRAUMATIC STUPOR AND COMA <1 HOUR WITH MCC","code_information":[{"code":"085","type":"MS-DRG"}],"standard_charges":[{"minimum":13922.44,"maximum":34119,"setting":"inpatient","payers_information":[{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":34119,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":30509,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":32567.08,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":28358,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":33532,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":30931,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":13922.44,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":16242.84,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":15469.37,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":15778.76,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":15778.76,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":15778.76,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":16772.05,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":16364.96,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":16283.54,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":17097.72,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":16690.63,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":16283.54,"methodology":"case rate"}]}]},{"description":"TRAUMATIC STUPOR AND COMA <1 HOUR WITH CC","code_information":[{"code":"086","type":"MS-DRG"}],"standard_charges":[{"minimum":8181.96,"maximum":19749,"setting":"inpatient","payers_information":[{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":19749,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":17659,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":19139.06,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":16414,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":19409,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":17903,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":8181.96,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":9545.62,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":9091.06,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":9272.89,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":9272.89,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":9272.89,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":9856.62,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":9617.38,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":9569.53,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":10048.01,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":9808.77,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":9569.53,"methodology":"case rate"}]}]},{"description":"RMVL PG WCS LV BOTH COMPNT","code_information":[{"code":"0861T","type":"CPT"},{"code":"0480","type":"RC"}],"standard_charges":[{"minimum":8776.95,"maximum":8776.95,"gross_charge":9645,"discounted_cash":4543.6,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":8776.95,"methodology":"fee schedule"}]}]},{"description":"RMVL PG WCS LV BOTH COMPNT","code_information":[{"code":"0861T","type":"CPT"},{"code":"0480","type":"RC"}],"standard_charges":[{"minimum":2265.62,"maximum":8776.95,"gross_charge":9645,"discounted_cash":4543.6,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6076.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6076.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6076.35,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6076.35,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6076.35,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":8776.95,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5979.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":7040.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":2604.15,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":2734.36,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":2552.07,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":2265.62,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2656.24,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2682.28,"methodology":"fee schedule"}]}]},{"description":"RLCJ PG WCS LV BATTERY ONLY","code_information":[{"code":"0862T","type":"CPT"},{"code":"0480","type":"RC"}],"standard_charges":[{"minimum":4075.89,"maximum":4075.89,"gross_charge":4479,"discounted_cash":2109.99,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4075.89,"methodology":"fee schedule"}]}]},{"description":"RLCJ PG WCS LV BATTERY ONLY","code_information":[{"code":"0862T","type":"CPT"},{"code":"0480","type":"RC"}],"standard_charges":[{"minimum":1052.12,"maximum":4075.89,"gross_charge":4479,"discounted_cash":2109.99,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2821.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2821.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2821.77,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2821.77,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2821.77,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4075.89,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2776.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":3269.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":1209.33,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":1269.8,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":1185.15,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":1052.12,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1233.52,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1245.61,"methodology":"fee schedule"}]}]},{"description":"RLCJ PG WCS LV TRNSMTR ONLY","code_information":[{"code":"0863T","type":"CPT"},{"code":"0480","type":"RC"}],"standard_charges":[{"minimum":4071.34,"maximum":4071.34,"gross_charge":4474,"discounted_cash":2107.63,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4071.34,"methodology":"fee schedule"}]}]},{"description":"RLCJ PG WCS LV TRNSMTR ONLY","code_information":[{"code":"0863T","type":"CPT"},{"code":"0480","type":"RC"}],"standard_charges":[{"minimum":1050.95,"maximum":4071.34,"gross_charge":4474,"discounted_cash":2107.63,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2818.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2818.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2818.62,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2818.62,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2818.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4071.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2773.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":3266.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":1207.98,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":1268.38,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":1183.83,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":1050.95,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1232.14,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1244.22,"methodology":"fee schedule"}]}]},{"description":"TRAUMATIC STUPOR AND COMA <1 HOUR WITHOUT CC/MCC","code_information":[{"code":"087","type":"MS-DRG"}],"standard_charges":[{"minimum":5610.06,"maximum":13310,"setting":"inpatient","payers_information":[{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":13310,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":11902,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":13122.92,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":11063,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13081,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":12067,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":5610.06,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":6545.06,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":6233.39,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":6358.06,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":6358.06,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6358.06,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6758.31,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":6594.27,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6561.46,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":6889.54,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6725.5,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":6561.46,"methodology":"case rate"}]}]},{"description":"CONCUSSION WITH MCC","code_information":[{"code":"088","type":"MS-DRG"}],"standard_charges":[{"minimum":8778.02,"maximum":21241,"setting":"inpatient","payers_information":[{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":21241,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":18994,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":20533.36,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":17654,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":20876,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":19256,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":8778.02,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":10241.02,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":9753.35,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":9948.42,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":9948.42,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":9948.42,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":10574.69,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":10318.02,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":10266.68,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":10780.02,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":10523.35,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":10266.68,"methodology":"case rate"}]}]},{"description":"CONCUSSION WITH CC","code_information":[{"code":"089","type":"MS-DRG"}],"standard_charges":[{"minimum":6741.43,"maximum":16143,"setting":"inpatient","payers_information":[{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":16143,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":14435,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":15769.4,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":13417,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15865,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":14634,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":6741.43,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":7865,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":7490.47,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":7640.28,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":7640.28,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":7640.28,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":8121.25,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":7924.13,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7884.7,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":8278.94,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":8081.82,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":7884.7,"methodology":"case rate"}]}]},{"description":"CONCUSSION WITHOUT CC/MCC","code_information":[{"code":"090","type":"MS-DRG"}],"standard_charges":[{"minimum":5449.46,"maximum":12908,"setting":"inpatient","payers_information":[{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":12908,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":11543,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":12747.26,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":10729,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12686,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":11702,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":5449.46,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":6357.7,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":6054.95,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":6176.05,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":6176.05,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6176.05,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6564.84,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":6405.5,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6373.63,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":6692.32,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6532.98,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":6373.63,"methodology":"case rate"}]}]},{"description":"OTHER DISORDERS OF NERVOUS SYSTEM WITH MCC","code_information":[{"code":"091","type":"MS-DRG"}],"standard_charges":[{"minimum":11257.29,"maximum":27447,"setting":"inpatient","payers_information":[{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":27447,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":24544,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":26332.84,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":22813,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":26975,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":24883,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":11257.29,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":13133.51,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":12508.1,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":12758.27,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":12758.27,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12758.27,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":13561.42,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":13232.26,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":13166.42,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":13824.75,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":13495.59,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":13166.42,"methodology":"case rate"}]}]},{"description":"OTHER DISORDERS OF NERVOUS SYSTEM WITH CC","code_information":[{"code":"092","type":"MS-DRG"}],"standard_charges":[{"minimum":6660.82,"maximum":15941,"setting":"inpatient","payers_information":[{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":15941,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":14254,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":15580.86,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":13249,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15667,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":14451,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":6660.82,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":7770.96,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":7400.91,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":7548.93,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":7548.93,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":7548.93,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":8024.15,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":7829.39,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7790.43,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":8179.96,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7985.2,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":7790.43,"methodology":"case rate"}]}]},{"description":"OTHER DISORDERS OF NERVOUS SYSTEM WITHOUT CC/MCC","code_information":[{"code":"093","type":"MS-DRG"}],"standard_charges":[{"minimum":5040.45,"maximum":11884,"setting":"inpatient","payers_information":[{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":11884,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":10627,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":11790.52,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":9878,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11680,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":10774,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":5040.45,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":5880.53,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":5600.5,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":5712.51,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":5712.51,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5712.51,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6072.12,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":5924.74,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5895.26,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":6190.03,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6042.65,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":5895.26,"methodology":"case rate"}]}]},{"description":"BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITH MCC","code_information":[{"code":"094","type":"MS-DRG"}],"standard_charges":[{"minimum":22239.02,"maximum":54938,"setting":"inpatient","payers_information":[{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":54938,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":49126,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":52021.08,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":45662,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":53993,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":49805,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":22239.02,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":25945.53,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":24710.02,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":25204.23,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":25204.23,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":25204.23,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":26790.86,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":26140.6,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":26010.54,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":27311.07,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":26660.81,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":26010.54,"methodology":"case rate"}]}]},{"description":"BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITH CC","code_information":[{"code":"095","type":"MS-DRG"}],"standard_charges":[{"minimum":14711.57,"maximum":36095,"setting":"inpatient","payers_information":[{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":36095,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":32276,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":34413,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":30000,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":35474,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":32722,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":14711.57,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":17163.49,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":16346.18,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":16673.11,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":16673.11,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":16673.11,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":17722.7,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":17292.54,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":17206.5,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":18066.83,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":17636.67,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":17206.5,"methodology":"case rate"}]}]},{"description":"BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITHOUT CC/MCC","code_information":[{"code":"096","type":"MS-DRG"}],"standard_charges":[{"minimum":14711.57,"maximum":36095,"setting":"inpatient","payers_information":[{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":36095,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":32276,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":34413,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":30000,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":35474,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":32722,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":14711.57,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":17163.49,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":16346.18,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":16673.11,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":16673.11,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":16673.11,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":17722.7,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":17292.54,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":17206.5,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":18066.83,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":17636.67,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":17206.5,"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":21853.47,"maximum":53973,"setting":"inpatient","payers_information":[{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":53973,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":48263,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":51119.22,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":44860,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":53045,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":48930,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":21853.47,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":25495.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":24281.63,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":24767.27,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":24767.27,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":24767.27,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":26326.4,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":25687.41,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":25559.61,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":26837.6,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":26198.61,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":25559.61,"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":13340.8,"maximum":32663,"setting":"inpatient","payers_information":[{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":32663,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":29207,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":31206.54,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":27148,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":32101,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":29611,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":13340.8,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":15564.27,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":14823.11,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":15119.58,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":15119.58,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":15119.58,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":16071.37,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":15681.29,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":15603.27,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":16383.44,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":15993.36,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":15603.27,"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":8673.36,"maximum":20979,"setting":"inpatient","payers_information":[{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":20979,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":18759,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":20288.54,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":17437,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":20618,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":19019,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":8673.36,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":10118.92,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":9637.06,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":9829.81,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":9829.81,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":9829.81,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":10448.6,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":10195,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":10144.27,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":10651.49,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":10397.88,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":10144.27,"methodology":"case rate"}]}]},{"description":"SEIZURES WITH MCC","code_information":[{"code":"100","type":"MS-DRG"}],"standard_charges":[{"minimum":12234.09,"maximum":29893,"setting":"inpatient","payers_information":[{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":29893,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":26730,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":28617.74,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":24845,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":29378,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":27099,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":12234.09,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":14273.11,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":13593.43,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":13865.3,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":13865.3,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13865.3,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":14738.14,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":14380.42,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":14308.87,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":15024.32,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":14666.6,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":14308.87,"methodology":"case rate"}]}]},{"description":"FNA BX W/O IMG GDN EA ADDL","code_information":[{"code":"10004","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"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|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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":52,"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":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"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":1993.81,"maximum":1993.81,"gross_charge":2191,"discounted_cash":1032.15,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1993.81,"methodology":"fee schedule"}]}]},{"description":"HC ASPIRATION FINE NEEDLE 10005","code_information":[{"code":"10005","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":514.67,"maximum":1993.81,"gross_charge":2191,"discounted_cash":1032.15,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1380.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1380.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1380.33,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":1382.52,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1380.33,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":1380.33,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1993.81,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1051.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":1643.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":591.57,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":621.15,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":579.74,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":514.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":603.41,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":609.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":712,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":691.26,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":691.26,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":725.82,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":718.91,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":691.26,"methodology":"case rate"}]}]},{"description":"HC FNA W/US EA ADD LESION","code_information":[{"code":"10006","type":"CPT"},{"code":"0402","type":"RC"}],"standard_charges":[{"minimum":1098.37,"maximum":1098.37,"gross_charge":1207,"discounted_cash":568.6,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1098.37,"methodology":"fee schedule"}]}]},{"description":"HC FNA W/US EA ADD LESION","code_information":[{"code":"10006","type":"CPT"},{"code":"0402","type":"RC"}],"standard_charges":[{"minimum":283.53,"maximum":1098.37,"gross_charge":1207,"discounted_cash":568.6,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":760.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":760.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":760.41,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":760.41,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":760.41,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":627.64,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1098.37,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":579.36,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":905.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":325.89,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":342.19,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":319.38,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":283.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":332.41,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":335.67,"methodology":"fee schedule"}]}]},{"description":"FNA BX W/FLUOR GDN 1ST LES","code_information":[{"code":"10007","type":"CPT"}],"standard_charges":[{"minimum":691.26,"maximum":1538.38,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":1382.52,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":712,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":691.26,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":691.26,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":725.82,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":718.91,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":691.26,"methodology":"case rate"}]}]},{"description":"FNA BX W/FLUOR GDN EA ADDL","code_information":[{"code":"10008","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"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|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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":52,"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":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"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":777.14,"maximum":777.14,"gross_charge":854,"discounted_cash":402.31,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":777.14,"methodology":"fee schedule"}]}]},{"description":"HC FINE NEEDLE ASPIRAT DEEP TISS","code_information":[{"code":"10009","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":200.61,"maximum":1538.38,"gross_charge":854,"discounted_cash":402.31,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":538.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":538.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":538.02,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":1382.52,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":538.02,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":538.02,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":777.14,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":409.92,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":640.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":230.58,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":242.11,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":225.97,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":200.61,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":235.2,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":237.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":712,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":691.26,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":691.26,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":725.82,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":718.91,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":691.26,"methodology":"case rate"}]}]},{"description":"FNA BX W/CT GDN EA ADDL","code_information":[{"code":"10010","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"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|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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":52,"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":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"FNA BX W/MR GDN 1ST LES","code_information":[{"code":"10011","type":"CPT"}],"standard_charges":[{"minimum":691.26,"maximum":1538.38,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":1382.52,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":712,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":691.26,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":691.26,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":725.82,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":718.91,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":691.26,"methodology":"case rate"}]}]},{"description":"FNA BX W/MR GDN EA ADDL","code_information":[{"code":"10012","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"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|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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":52,"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":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC FNA W/O IMAGING GND 1ST LES","code_information":[{"code":"10021","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":607.88,"maximum":607.88,"gross_charge":668,"discounted_cash":314.69,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":607.88,"methodology":"fee schedule"}]}]},{"description":"HC FNA W/O IMAGING GND 1ST LES","code_information":[{"code":"10021","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":156.92,"maximum":1538.38,"gross_charge":668,"discounted_cash":314.69,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":420.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":420.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":420.84,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":785.06,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":420.84,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":420.84,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":607.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":320.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":501,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":180.36,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":189.38,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":176.76,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":156.92,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":183.97,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":185.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":404.31,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":392.53,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":392.53,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":412.16,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":408.23,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":392.53,"methodology":"case rate"}]}]},{"description":"HC IMAGE GUIDED CATH PLACEMENT","code_information":[{"code":"10030","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":2584.4,"maximum":2584.4,"gross_charge":2840,"discounted_cash":1337.88,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2584.4,"methodology":"fee schedule"}]}]},{"description":"HC IMAGE GUIDED CATH PLACEMENT","code_information":[{"code":"10030","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":667.12,"maximum":2584.4,"gross_charge":2840,"discounted_cash":1337.88,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1789.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1789.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1789.2,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2152,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":1821,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":1382.52,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1789.2,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":1789.2,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2584.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1363.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":2130,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":766.8,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":805.14,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":751.47,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":667.12,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":782.14,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":789.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":712,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":691.26,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":691.26,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":725.82,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":718.91,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":691.26,"methodology":"case rate"}]}]},{"description":"PERQ DEV SOFT TISS 1ST IMAG","code_information":[{"code":"10035","type":"CPT"}],"standard_charges":[{"minimum":691.26,"maximum":1382.52,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":1382.52,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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":52,"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":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":712,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":691.26,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":691.26,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":725.82,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":718.91,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":691.26,"methodology":"case rate"}]}]},{"description":"PERQ DEV SOFT TISS ADD IMAG","code_information":[{"code":"10036","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"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|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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":52,"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":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC ACNE SURGERY OF SKIN ABSCESS","code_information":[{"code":"10040","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":352.17,"maximum":352.17,"gross_charge":387,"discounted_cash":182.31,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":352.17,"methodology":"fee schedule"}]}]},{"description":"HC ACNE SURGERY OF SKIN ABSCESS","code_information":[{"code":"10040","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":90.91,"maximum":1538.38,"gross_charge":387,"discounted_cash":182.31,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":243.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":243.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":243.81,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":205.11,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":181.89,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":390.44,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":243.81,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":243.81,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":352.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":185.76,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":290.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":104.49,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":109.72,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":102.41,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":90.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":106.58,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":107.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":201.08,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":195.22,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":195.22,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":204.98,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":203.03,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":195.22,"methodology":"case rate"}]}]},{"description":"HC I&D ABSC SIMPL OR SGL","code_information":[{"code":"10060","type":"CPT"},{"code":"0761","type":"RC"}],"standard_charges":[{"minimum":580.58,"maximum":580.58,"gross_charge":638,"discounted_cash":300.56,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":580.58,"methodology":"fee schedule"}]}]},{"description":"HC I&D ABSC SIMPL OR SGL","code_information":[{"code":"10060","type":"CPT"},{"code":"0761","type":"RC"}],"standard_charges":[{"minimum":149.87,"maximum":2152,"gross_charge":638,"discounted_cash":300.56,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":401.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":401.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":401.94,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2152,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":1821,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":390.44,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":401.94,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":401.94,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":580.58,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":306.24,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":478.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":172.26,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":180.88,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":168.82,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":149.87,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":175.71,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":177.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":201.08,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":195.22,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":195.22,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":204.98,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":203.03,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":195.22,"methodology":"case rate"}]}]},{"description":"HC I&D ABSCESS COMPL/MULTI","code_information":[{"code":"10061","type":"CPT"},{"code":"0761","type":"RC"}],"standard_charges":[{"minimum":817.18,"maximum":817.18,"gross_charge":898,"discounted_cash":423.04,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":817.18,"methodology":"fee schedule"}]}]},{"description":"HC I&D ABSCESS COMPL/MULTI","code_information":[{"code":"10061","type":"CPT"},{"code":"0761","type":"RC"}],"standard_charges":[{"minimum":210.95,"maximum":2152,"gross_charge":898,"discounted_cash":423.04,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":565.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":565.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":565.74,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2152,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":1821,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":785.06,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":565.74,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":565.74,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":817.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":431.04,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":673.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":242.46,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":254.59,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":237.62,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":210.95,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":247.31,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":249.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":404.31,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":392.53,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":392.53,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":412.16,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":408.23,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":392.53,"methodology":"case rate"}]}]},{"description":"HC I&D PILONIDAL CYST SIMPLE","code_information":[{"code":"10080","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":849.94,"maximum":849.94,"gross_charge":934,"discounted_cash":440,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":849.94,"methodology":"fee schedule"}]}]},{"description":"HC I&D PILONIDAL CYST SIMPLE","code_information":[{"code":"10080","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":219.4,"maximum":2152,"gross_charge":934,"discounted_cash":440,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":588.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":588.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":588.42,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2152,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":1821,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":1382.52,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":588.42,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":588.42,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":849.94,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":448.32,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":700.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":252.18,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":264.79,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":247.14,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":219.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":257.23,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":259.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":712,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":691.26,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":691.26,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":725.82,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":718.91,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":691.26,"methodology":"case rate"}]}]},{"description":"HC I&D PILONIDAL CYST COMPLC","code_information":[{"code":"10081","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":994.63,"maximum":994.63,"gross_charge":1093,"discounted_cash":514.9,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":994.63,"methodology":"fee schedule"}]}]},{"description":"HC I&D PILONIDAL CYST COMPLC","code_information":[{"code":"10081","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":256.75,"maximum":2376,"gross_charge":1093,"discounted_cash":514.9,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":688.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":688.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":688.59,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2376,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":2011,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":1382.52,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":688.59,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":688.59,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":994.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":524.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":819.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":295.11,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":309.87,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":289.21,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":256.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":301.02,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":303.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":712,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":691.26,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":691.26,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":725.82,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":718.91,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":691.26,"methodology":"case rate"}]}]},{"description":"SEIZURES WITHOUT MCC","code_information":[{"code":"101","type":"MS-DRG"}],"standard_charges":[{"minimum":5836.81,"maximum":13878,"setting":"inpatient","payers_information":[{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":13878,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":12410,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":13653.34,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":11535,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13639,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":12581,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":5836.81,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":6809.61,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":6485.34,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":6615.05,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":6615.05,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6615.05,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":7031.48,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":6860.81,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6826.67,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":7168.01,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6997.34,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":6826.67,"methodology":"case rate"}]}]},{"description":"HC INC&REMV FOREIGN BODY SMPL","code_information":[{"code":"10120","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":1029.21,"maximum":1029.21,"gross_charge":1131,"discounted_cash":532.8,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1029.21,"methodology":"fee schedule"}]}]},{"description":"HC INC&REMV FOREIGN BODY SMPL","code_information":[{"code":"10120","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":265.68,"maximum":2152,"gross_charge":1131,"discounted_cash":532.8,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":712.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":712.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":712.53,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2152,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":1821,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":785.06,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":712.53,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":712.53,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1029.21,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":542.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":848.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":305.37,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":320.64,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":299.27,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":265.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":311.48,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":314.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":404.31,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":392.53,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":392.53,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":412.16,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":408.23,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":392.53,"methodology":"case rate"}]}]},{"description":"HC REMOVE FOREIGN BODY COMPLIC","code_information":[{"code":"10121","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":2602.6,"maximum":2602.6,"gross_charge":2860,"discounted_cash":1347.3,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2602.6,"methodology":"fee schedule"}]}]},{"description":"HC REMOVE FOREIGN BODY COMPLIC","code_information":[{"code":"10121","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":671.82,"maximum":3183.7,"gross_charge":2860,"discounted_cash":1347.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1801.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1801.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1801.8,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2376,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":2011,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":3183.7,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1801.8,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":1801.8,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1923.63,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2602.6,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1372.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":2145,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":772.2,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":810.81,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":756.76,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":671.82,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":787.65,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":795.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1639.61,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":1591.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1591.85,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":1671.44,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1655.52,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":1591.85,"methodology":"case rate"}]}]},{"description":"HC I&D HEMATOMA FLUID","code_information":[{"code":"10140","type":"CPT"},{"code":"0761","type":"RC"}],"standard_charges":[{"minimum":1356.81,"maximum":1356.81,"gross_charge":1491,"discounted_cash":702.39,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1356.81,"methodology":"fee schedule"}]}]},{"description":"HC I&D HEMATOMA FLUID","code_information":[{"code":"10140","type":"CPT"},{"code":"0761","type":"RC"}],"standard_charges":[{"minimum":350.24,"maximum":4157,"gross_charge":1491,"discounted_cash":702.39,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":939.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":939.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":939.33,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":4157,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3517,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":3183.7,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":939.33,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":939.33,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1356.81,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":715.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":1118.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":402.57,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":422.7,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":394.52,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":350.24,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":410.63,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":414.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1639.61,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":1591.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1591.85,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":1671.44,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1655.52,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":1591.85,"methodology":"case rate"}]}]},{"description":"I&D SKINSUBCU & OTHER STRUCT","code_information":[{"code":"10140","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":4368,"maximum":4368,"gross_charge":4800,"discounted_cash":2261.2,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4368,"methodology":"fee schedule"}]}]},{"description":"I&D SKINSUBCU & OTHER STRUCT","code_information":[{"code":"10140","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":1127.52,"maximum":4368,"gross_charge":4800,"discounted_cash":2261.2,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3024,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3024,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3024,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":4157,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3517,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":3183.7,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3024,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3024,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4368,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2304,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":3600,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":1296,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":1360.8,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":1270.08,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":1127.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1321.92,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1334.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1639.61,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":1591.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1591.85,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":1671.44,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1655.52,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":1591.85,"methodology":"case rate"}]}]},{"description":"HC I&D PUNCTURE ASPIRATION","code_information":[{"code":"10160","type":"CPT"},{"code":"0761","type":"RC"}],"standard_charges":[{"minimum":589.68,"maximum":589.68,"gross_charge":648,"discounted_cash":305.27,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":589.68,"methodology":"fee schedule"}]}]},{"description":"HC I&D PUNCTURE ASPIRATION","code_information":[{"code":"10160","type":"CPT"},{"code":"0761","type":"RC"}],"standard_charges":[{"minimum":152.22,"maximum":1538.38,"gross_charge":648,"discounted_cash":305.27,"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":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":785.06,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":408.24,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":408.24,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":589.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":311.04,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":486,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":174.96,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":183.71,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":171.47,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":152.22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":178.46,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":180.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":404.31,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":392.53,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":392.53,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":412.16,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":408.23,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":392.53,"methodology":"case rate"}]}]},{"description":"HC I&D POST OP WOUND INFECT","code_information":[{"code":"10180","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":2427.88,"maximum":2427.88,"gross_charge":2668,"discounted_cash":1256.85,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2427.88,"methodology":"fee schedule"}]}]},{"description":"HC I&D POST OP WOUND INFECT","code_information":[{"code":"10180","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":626.72,"maximum":5623.82,"gross_charge":2668,"discounted_cash":1256.85,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1680.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1680.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1680.84,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2376,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":2011,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":5623.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1680.84,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":1680.84,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1923.63,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2427.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1280.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":2001,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":720.36,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":756.38,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":705.96,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":626.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":734.77,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":741.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2896.27,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":2811.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2811.91,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":2952.51,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2924.39,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":2811.91,"methodology":"case rate"}]}]},{"description":"HEADACHES WITH MCC","code_information":[{"code":"102","type":"MS-DRG"}],"standard_charges":[{"minimum":7267.12,"maximum":17459,"setting":"inpatient","payers_information":[{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":17459,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":15612,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":16999.08,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":14511,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17158,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":15827,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":7267.12,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":8478.3,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":8074.57,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":8236.07,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":8236.07,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":8236.07,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":8754.53,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":8542.04,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":8499.54,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":8924.52,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":8712.03,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":8499.54,"methodology":"case rate"}]}]},{"description":"HEADACHES WITHOUT MCC","code_information":[{"code":"103","type":"MS-DRG"}],"standard_charges":[{"minimum":5406.75,"maximum":12801,"setting":"inpatient","payers_information":[{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":12801,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":11447,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":12647.36,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":10640,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12581,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":11605,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":5406.75,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":6307.88,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":6007.5,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":6127.65,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":6127.65,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6127.65,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6513.4,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":6355.3,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6323.68,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":6639.87,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6481.78,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":6323.68,"methodology":"case rate"}]}]},{"description":"HC DEBR EXZ/INF SKIN TO 10%","code_information":[{"code":"11000","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":671.58,"maximum":671.58,"gross_charge":738,"discounted_cash":347.66,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":671.58,"methodology":"fee schedule"}]}]},{"description":"HC DEBR EXZ/INF SKIN TO 10%","code_information":[{"code":"11000","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":173.36,"maximum":1538.38,"gross_charge":738,"discounted_cash":347.66,"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":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":391.14,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":346.86,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":1202.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":464.94,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":464.94,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":671.58,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":354.24,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":553.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":199.26,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":209.23,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":195.28,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":173.36,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":203.25,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":205.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":619.45,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":601.41,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":601.41,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":631.48,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":625.47,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":601.41,"methodology":"case rate"}]}]},{"description":"DEBRIDE INFECTED SKIN ADD-ON","code_information":[{"code":"11001","type":"CPT"}],"standard_charges":[{"minimum":1538.38,"maximum":1538.38,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"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|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"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":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"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|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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":52,"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":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"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":1941.94,"maximum":1941.94,"gross_charge":2134,"discounted_cash":1005.3,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1941.94,"methodology":"fee schedule"}]}]},{"description":"HC DEBRIDEMENT OF FATTY NECROSIS","code_information":[{"code":"11005","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":501.28,"maximum":2152,"gross_charge":2134,"discounted_cash":1005.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1344.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1344.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1344.42,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2152,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":1821,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1344.42,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":1344.42,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1109.68,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1941.94,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1024.32,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":1600.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":576.18,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":604.99,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":564.66,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":501.28,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":587.71,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":593.47,"methodology":"fee schedule"}]}]},{"description":"DEBRIDE GENIT/PER/ABDOM WALL","code_information":[{"code":"11006","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"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|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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":52,"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":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"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":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"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|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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":52,"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":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC DEBRIDE ASSOC OPEN FX/DISLOC SKIN/SUBQ","code_information":[{"code":"11010","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":942.76,"maximum":942.76,"gross_charge":1036,"discounted_cash":488.05,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":942.76,"methodology":"fee schedule"}]}]},{"description":"HC DEBRIDE ASSOC OPEN FX/DISLOC SKIN/SUBQ","code_information":[{"code":"11010","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":243.36,"maximum":2376,"gross_charge":1036,"discounted_cash":488.05,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":652.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":652.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":652.68,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2376,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":2011,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":1382.52,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":652.68,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":652.68,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1923.63,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":942.76,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":497.28,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":777,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":279.72,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":293.71,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":274.13,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":243.36,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":285.32,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":288.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":712,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":691.26,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":691.26,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":725.82,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":718.91,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":691.26,"methodology":"case rate"}]}]},{"description":"DEBRIDE SKIN MUSC AT FX SITE","code_information":[{"code":"11011","type":"CPT"}],"standard_charges":[{"minimum":691.26,"maximum":2376,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2376,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":2011,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":1382.52,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1923.63,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":712,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":691.26,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":691.26,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":725.82,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":718.91,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":691.26,"methodology":"case rate"}]}]},{"description":"HC DEB SKIN BONE AT FX SITE","code_information":[{"code":"11012","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":2385.11,"maximum":2385.11,"gross_charge":2621,"discounted_cash":1234.71,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2385.11,"methodology":"fee schedule"}]}]},{"description":"HC DEB SKIN BONE AT FX SITE","code_information":[{"code":"11012","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":615.68,"maximum":5623.82,"gross_charge":2621,"discounted_cash":1234.71,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1651.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1651.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1651.23,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2376,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":2011,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":5623.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1651.23,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":1651.23,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1923.63,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2385.11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1258.08,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":1965.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":707.67,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":743.06,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":693.52,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":615.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":721.83,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":728.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2896.27,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":2811.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2811.91,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":2952.51,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2924.39,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":2811.91,"methodology":"case rate"}]}]},{"description":"HC DEB SQ TISS IST 20SQCM/<","code_information":[{"code":"11042","type":"CPT"},{"code":"0761","type":"RC"}],"standard_charges":[{"minimum":1413.23,"maximum":1413.23,"gross_charge":1553,"discounted_cash":731.6,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1413.23,"methodology":"fee schedule"}]}]},{"description":"HC DEB SQ TISS IST 20SQCM/<","code_information":[{"code":"11042","type":"CPT"},{"code":"0761","type":"RC"}],"standard_charges":[{"minimum":364.8,"maximum":2376,"gross_charge":1553,"discounted_cash":731.6,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":978.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":978.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":978.39,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2376,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":2011,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":785.06,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":978.39,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":978.39,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1923.63,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1413.23,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":745.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":1164.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":419.31,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":440.28,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":410.93,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":364.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":427.7,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":431.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":404.31,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":392.53,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":392.53,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":412.16,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":408.23,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":392.53,"methodology":"case rate"}]}]},{"description":"HC DEB MUSC/FASC 20SQCM/<","code_information":[{"code":"11043","type":"CPT"},{"code":"0761","type":"RC"}],"standard_charges":[{"minimum":2021.11,"maximum":2021.11,"gross_charge":2221,"discounted_cash":1046.28,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2021.11,"methodology":"fee schedule"}]}]},{"description":"HC DEB MUSC/FASC 20SQCM/<","code_information":[{"code":"11043","type":"CPT"},{"code":"0761","type":"RC"}],"standard_charges":[{"minimum":521.72,"maximum":2376,"gross_charge":2221,"discounted_cash":1046.28,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1399.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1399.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1399.23,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2376,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":2011,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":1202.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1399.23,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":1399.23,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1923.63,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2021.11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1066.08,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":1665.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":599.67,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":629.66,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":587.68,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":521.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":611.67,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":617.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":619.45,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":601.41,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":601.41,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":631.48,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":625.47,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":601.41,"methodology":"case rate"}]}]},{"description":"HC DEB BONE 20SQCM/<","code_information":[{"code":"11044","type":"CPT"},{"code":"0761","type":"RC"}],"standard_charges":[{"minimum":2317.77,"maximum":2317.77,"gross_charge":2547,"discounted_cash":1199.85,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2317.77,"methodology":"fee schedule"}]}]},{"description":"HC DEB BONE 20SQCM/<","code_information":[{"code":"11044","type":"CPT"},{"code":"0761","type":"RC"}],"standard_charges":[{"minimum":598.3,"maximum":3183.7,"gross_charge":2547,"discounted_cash":1199.85,"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":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2376,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":2011,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":3183.7,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1604.61,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":1604.61,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1923.63,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2317.77,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1222.56,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":1910.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":687.69,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":722.08,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":673.94,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":598.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":701.45,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":708.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1639.61,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":1591.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1591.85,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":1671.44,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1655.52,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":1591.85,"methodology":"case rate"}]}]},{"description":"HC DEB SQ TISS ADD 20SQCM<","code_information":[{"code":"11045","type":"CPT"},{"code":"0761","type":"RC"}],"standard_charges":[{"minimum":452.27,"maximum":452.27,"gross_charge":497,"discounted_cash":234.13,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":452.27,"methodology":"fee schedule"}]}]},{"description":"HC DEB SQ TISS ADD 20SQCM<","code_information":[{"code":"11045","type":"CPT"},{"code":"0761","type":"RC"}],"standard_charges":[{"minimum":116.75,"maximum":452.27,"gross_charge":497,"discounted_cash":234.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":313.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":313.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":313.11,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":313.11,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":313.11,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":258.44,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":452.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":238.56,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":372.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":134.19,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":140.9,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":131.51,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":116.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":136.88,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":138.22,"methodology":"fee schedule"}]}]},{"description":"HC DEB MUSC/FAS + 20SQCM<","code_information":[{"code":"11046","type":"CPT"},{"code":"0761","type":"RC"}],"standard_charges":[{"minimum":1017.38,"maximum":1017.38,"gross_charge":1118,"discounted_cash":526.68,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1017.38,"methodology":"fee schedule"}]}]},{"description":"HC DEB MUSC/FAS + 20SQCM<","code_information":[{"code":"11046","type":"CPT"},{"code":"0761","type":"RC"}],"standard_charges":[{"minimum":262.62,"maximum":1017.38,"gross_charge":1118,"discounted_cash":526.68,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":704.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":704.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":704.34,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":704.34,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":704.34,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":581.36,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1017.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":536.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":838.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":301.86,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":316.96,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":295.83,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":262.62,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":307.9,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":310.92,"methodology":"fee schedule"}]}]},{"description":"DEB BONE EA ADD 20SQ CM","code_information":[{"code":"11047","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":508.69,"maximum":508.69,"gross_charge":559,"discounted_cash":263.34,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":508.69,"methodology":"fee schedule"}]}]},{"description":"DEB BONE EA ADD 20SQ CM","code_information":[{"code":"11047","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":131.31,"maximum":508.69,"gross_charge":559,"discounted_cash":263.34,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":352.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":352.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":352.17,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":352.17,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":352.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":290.68,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":508.69,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":268.32,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":419.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":150.93,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":158.48,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":147.92,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":131.31,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":153.95,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":155.46,"methodology":"fee schedule"}]}]},{"description":"HC PARE BENIGN LESION;SGL","code_information":[{"code":"11055","type":"CPT"},{"code":"0761","type":"RC"}],"standard_charges":[{"minimum":420.42,"maximum":420.42,"gross_charge":462,"discounted_cash":217.65,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":420.42,"methodology":"fee schedule"}]}]},{"description":"HC PARE BENIGN LESION;SGL","code_information":[{"code":"11055","type":"CPT"},{"code":"0761","type":"RC"}],"standard_charges":[{"minimum":108.53,"maximum":1538.38,"gross_charge":462,"discounted_cash":217.65,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":291.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":291.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":291.06,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":390.44,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":291.06,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":291.06,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":420.42,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":221.76,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":346.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":124.74,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":130.98,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":122.25,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":108.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":127.24,"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":201.08,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":195.22,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":195.22,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":204.98,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":203.03,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":195.22,"methodology":"case rate"}]}]},{"description":"HC PARE BENIGN LESION;2-4 LES","code_information":[{"code":"11056","type":"CPT"},{"code":"0761","type":"RC"}],"standard_charges":[{"minimum":420.42,"maximum":420.42,"gross_charge":462,"discounted_cash":217.65,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":420.42,"methodology":"fee schedule"}]}]},{"description":"HC PARE BENIGN LESION;2-4 LES","code_information":[{"code":"11056","type":"CPT"},{"code":"0761","type":"RC"}],"standard_charges":[{"minimum":108.53,"maximum":1538.38,"gross_charge":462,"discounted_cash":217.65,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":291.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":291.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":291.06,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":390.44,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":291.06,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":291.06,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":420.42,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":221.76,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":346.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":124.74,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":130.98,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":122.25,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":108.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":127.24,"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":201.08,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":195.22,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":195.22,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":204.98,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":203.03,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":195.22,"methodology":"case rate"}]}]},{"description":"HC PARE BENIGN LESION;>4 LES","code_information":[{"code":"11057","type":"CPT"},{"code":"0761","type":"RC"}],"standard_charges":[{"minimum":420.42,"maximum":420.42,"gross_charge":462,"discounted_cash":217.65,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":420.42,"methodology":"fee schedule"}]}]},{"description":"HC PARE BENIGN LESION;>4 LES","code_information":[{"code":"11057","type":"CPT"},{"code":"0761","type":"RC"}],"standard_charges":[{"minimum":108.53,"maximum":1538.38,"gross_charge":462,"discounted_cash":217.65,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":291.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":291.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":291.06,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":390.44,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":291.06,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":291.06,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":420.42,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":221.76,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":346.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":124.74,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":130.98,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":122.25,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":108.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":127.24,"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":201.08,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":195.22,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":195.22,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":204.98,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":203.03,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":195.22,"methodology":"case rate"}]}]},{"description":"HC TANGENTIAL BIOPSY SINGLE","code_information":[{"code":"11102","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":175.63,"maximum":175.63,"gross_charge":193,"discounted_cash":90.92,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":175.63,"methodology":"fee schedule"}]}]},{"description":"HC TANGENTIAL BIOPSY SINGLE","code_information":[{"code":"11102","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":45.34,"maximum":1538.38,"gross_charge":193,"discounted_cash":90.92,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":121.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":121.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":121.59,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":390.44,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":121.59,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":121.59,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":175.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":92.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":144.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":52.11,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":54.72,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":51.07,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":45.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":53.16,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":53.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":201.08,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":195.22,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":195.22,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":204.98,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":203.03,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":195.22,"methodology":"case rate"}]}]},{"description":"TANGNTL BX SKIN EA SEP/ADDL","code_information":[{"code":"11103","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"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|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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":52,"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":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"median_amount":738.09,"10th_percentile":738.09,"90th_percentile":738.09,"count":"1 through 10","methodology":"percent of total billed charges"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC PUNCH BIOPSY SINGLE","code_information":[{"code":"11104","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":443.17,"maximum":443.17,"gross_charge":487,"discounted_cash":229.42,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":443.17,"methodology":"fee schedule"}]}]},{"description":"HC PUNCH BIOPSY SINGLE","code_information":[{"code":"11104","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":114.4,"maximum":1538.38,"gross_charge":487,"discounted_cash":229.42,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":306.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":306.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":306.81,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":785.06,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":306.81,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":306.81,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":443.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":233.76,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":365.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":131.49,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":138.07,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":128.87,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":114.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":134.12,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":135.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":404.31,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":392.53,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":392.53,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":412.16,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":408.23,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":392.53,"methodology":"case rate"}]}]},{"description":"HC PUNCH BX SKIN SINGLE LESION","code_information":[{"code":"11104","type":"CPT"},{"code":"0761","type":"RC"}],"standard_charges":[{"minimum":443.17,"maximum":443.17,"gross_charge":487,"discounted_cash":229.42,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":443.17,"methodology":"fee schedule"}]}]},{"description":"HC PUNCH BX SKIN SINGLE LESION","code_information":[{"code":"11104","type":"CPT"},{"code":"0761","type":"RC"}],"standard_charges":[{"minimum":114.4,"maximum":1538.38,"gross_charge":487,"discounted_cash":229.42,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":306.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":306.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":306.81,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":785.06,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":306.81,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":306.81,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":443.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":233.76,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":365.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":131.49,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":138.07,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":128.87,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":114.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":134.12,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":135.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":404.31,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":392.53,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":392.53,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":412.16,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":408.23,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":392.53,"methodology":"case rate"}]}]},{"description":"HC PUNCH BIOP ADDITIONAL","code_information":[{"code":"11105","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":237.51,"maximum":237.51,"gross_charge":261,"discounted_cash":122.96,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":237.51,"methodology":"fee schedule"}]}]},{"description":"HC PUNCH BIOP ADDITIONAL","code_information":[{"code":"11105","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":61.31,"maximum":237.51,"gross_charge":261,"discounted_cash":122.96,"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":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":164.43,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":164.43,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":135.72,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":237.51,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":125.28,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":195.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":70.47,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":74,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":69.07,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":61.31,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":71.88,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":72.59,"methodology":"fee schedule"}]}]},{"description":"HC INCISIONAL BIOP SINGLE","code_information":[{"code":"11106","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":940.94,"maximum":940.94,"gross_charge":1034,"discounted_cash":487.1,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":940.94,"methodology":"fee schedule"}]}]},{"description":"HC INCISIONAL BIOP SINGLE","code_information":[{"code":"11106","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":242.89,"maximum":2152,"gross_charge":1034,"discounted_cash":487.1,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":651.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":651.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":651.42,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2152,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":1821,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":1202.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":651.42,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":651.42,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":940.94,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":496.32,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":775.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":279.18,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":293.14,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":273.6,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":242.89,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":284.77,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":287.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":619.45,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":601.41,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":601.41,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":631.48,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":625.47,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":601.41,"methodology":"case rate"}]}]},{"description":"INCAL BX SKN EA SEP/ADDL","code_information":[{"code":"11107","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"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|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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":52,"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":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC REM SKIN TAGS <=15 LESIONS","code_information":[{"code":"11200","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":318.5,"maximum":318.5,"gross_charge":350,"discounted_cash":164.88,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":318.5,"methodology":"fee schedule"}]}]},{"description":"HC REM SKIN TAGS <=15 LESIONS","code_information":[{"code":"11200","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":82.22,"maximum":2152,"gross_charge":350,"discounted_cash":164.88,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":220.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":220.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":220.5,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2152,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":1821,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":390.44,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":220.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":220.5,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":318.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":168,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":262.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":94.5,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":99.23,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":92.61,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":82.22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":96.39,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":97.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":201.08,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":195.22,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":195.22,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":204.98,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":203.03,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":195.22,"methodology":"case rate"}]}]},{"description":"REMOVE SKIN TAGS ADD-ON","code_information":[{"code":"11201","type":"CPT"}],"standard_charges":[{"minimum":1538.38,"maximum":1538.38,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"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|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"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":13865.89,"maximum":33978,"setting":"inpatient","payers_information":[{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":33978,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":30383,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":32434.82,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":28240,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":33393,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":30803,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":13865.89,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":16176.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":15406.54,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":15714.68,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":15714.68,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":15714.68,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":16703.94,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":16298.5,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":16217.41,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":17028.29,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":16622.85,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":16217.41,"methodology":"case rate"}]}]},{"description":"SHAVE SKIN LESION 0.5 CM/<","code_information":[{"code":"11300","type":"CPT"}],"standard_charges":[{"minimum":392.53,"maximum":1538.38,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":785.06,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":404.31,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":392.53,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":392.53,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":412.16,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":408.23,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":392.53,"methodology":"case rate"}]}]},{"description":"HC SHAVE SKIN LES 6-10MM T/A/L","code_information":[{"code":"11301","type":"CPT"},{"code":"0510","type":"RC"}],"standard_charges":[{"minimum":310.31,"maximum":310.31,"gross_charge":341,"discounted_cash":160.64,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":310.31,"methodology":"fee schedule"}]}]},{"description":"HC SHAVE SKIN LES 6-10MM T/A/L","code_information":[{"code":"11301","type":"CPT"},{"code":"0510","type":"RC"}],"standard_charges":[{"minimum":80.11,"maximum":1538.38,"gross_charge":341,"discounted_cash":160.64,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":214.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":214.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":214.83,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":180.73,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":160.27,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":390.44,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":214.83,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":214.83,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":310.31,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":163.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":255.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":92.07,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":96.68,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":90.23,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":80.11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":93.92,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":94.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":201.08,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":195.22,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":195.22,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":204.98,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":203.03,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":195.22,"methodology":"case rate"}]}]},{"description":"HC SHAV SKIN LES 1.1-2.0 CM TRUNKARMLEG","code_information":[{"code":"11302","type":"CPT"},{"code":"0360","type":"RC"}],"standard_charges":[{"minimum":1802.71,"maximum":1802.71,"gross_charge":1981,"discounted_cash":933.22,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1802.71,"methodology":"fee schedule"}]}]},{"description":"HC SHAV SKIN LES 1.1-2.0 CM TRUNKARMLEG","code_information":[{"code":"11302","type":"CPT"},{"code":"0360","type":"RC"}],"standard_charges":[{"minimum":195.22,"maximum":1802.71,"gross_charge":1981,"discounted_cash":933.22,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1248.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1248.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1248.03,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":390.44,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1248.03,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":1248.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1802.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":950.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":1485.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":534.87,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":561.62,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":524.18,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":465.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":545.57,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":550.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":201.08,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":195.22,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":195.22,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":204.98,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":203.03,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":195.22,"methodology":"case rate"}]}]},{"description":"SHAVE SKIN LESION >2.0 CM","code_information":[{"code":"11303","type":"CPT"}],"standard_charges":[{"minimum":392.53,"maximum":1538.38,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":785.06,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":404.31,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":392.53,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":392.53,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":412.16,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":408.23,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":392.53,"methodology":"case rate"}]}]},{"description":"SHAVE SKIN LESION 0.5 CM/<","code_information":[{"code":"11305","type":"CPT"}],"standard_charges":[{"minimum":195.22,"maximum":1538.38,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":390.44,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":201.08,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":195.22,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":195.22,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":204.98,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":203.03,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":195.22,"methodology":"case rate"}]}]},{"description":"HC SHAV SKIN LES 0.6-1.0 CM REMAINDER BODY","code_information":[{"code":"11306","type":"CPT"},{"code":"0761","type":"RC"}],"standard_charges":[{"minimum":352.17,"maximum":352.17,"gross_charge":387,"discounted_cash":182.31,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":352.17,"methodology":"fee schedule"}]}]},{"description":"HC SHAV SKIN LES 0.6-1.0 CM REMAINDER BODY","code_information":[{"code":"11306","type":"CPT"},{"code":"0761","type":"RC"}],"standard_charges":[{"minimum":90.91,"maximum":1538.38,"gross_charge":387,"discounted_cash":182.31,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":243.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":243.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":243.81,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":390.44,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":243.81,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":243.81,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":352.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":185.76,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":290.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":104.49,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":109.72,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":102.41,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":90.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":106.58,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":107.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":201.08,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":195.22,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":195.22,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":204.98,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":203.03,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":195.22,"methodology":"case rate"}]}]},{"description":"SHAVE SKIN LESION 1.1-2.0 CM","code_information":[{"code":"11307","type":"CPT"}],"standard_charges":[{"minimum":195.22,"maximum":1538.38,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":390.44,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":201.08,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":195.22,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":195.22,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":204.98,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":203.03,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":195.22,"methodology":"case rate"}]}]},{"description":"SHAVE SKIN LESION >2.0 CM","code_information":[{"code":"11308","type":"CPT"}],"standard_charges":[{"minimum":392.53,"maximum":1538.38,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":785.06,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":404.31,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":392.53,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":392.53,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":412.16,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":408.23,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":392.53,"methodology":"case rate"}]}]},{"description":"SHAVE SKIN LESION 0.5 CM/<","code_information":[{"code":"11310","type":"CPT"}],"standard_charges":[{"minimum":195.22,"maximum":1538.38,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":390.44,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":201.08,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":195.22,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":195.22,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":204.98,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":203.03,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":195.22,"methodology":"case rate"}]}]},{"description":"SHAVE SKIN LESION 0.6-1.0 CM","code_information":[{"code":"11311","type":"CPT"}],"standard_charges":[{"minimum":195.22,"maximum":1538.38,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":390.44,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":201.08,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":195.22,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":195.22,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":204.98,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":203.03,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":195.22,"methodology":"case rate"}]}]},{"description":"SHAVE SKIN LESION 1.1-2.0 CM","code_information":[{"code":"11312","type":"CPT"}],"standard_charges":[{"minimum":392.53,"maximum":1538.38,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":785.06,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":404.31,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":392.53,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":392.53,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":412.16,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":408.23,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":392.53,"methodology":"case rate"}]}]},{"description":"SHAVE SKIN LESION >2.0 CM","code_information":[{"code":"11313","type":"CPT"}],"standard_charges":[{"minimum":392.53,"maximum":1538.38,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":785.06,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":404.31,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":392.53,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":392.53,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":412.16,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":408.23,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":392.53,"methodology":"case rate"}]}]},{"description":"ORBITAL PROCEDURES WITHOUT CC/MCC","code_information":[{"code":"114","type":"MS-DRG"}],"standard_charges":[{"minimum":7403.05,"maximum":17799,"setting":"inpatient","payers_information":[{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":17799,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":15916,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":17317.06,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":14793,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17493,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":16136,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":7403.05,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":8636.9,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":8225.61,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":8390.13,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":8390.13,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":8390.13,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":8918.29,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":8701.83,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":8658.53,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":9091.46,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":8875,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":8658.53,"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":1358.63,"maximum":1358.63,"gross_charge":1493,"discounted_cash":703.33,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1358.63,"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":350.71,"maximum":2152,"gross_charge":1493,"discounted_cash":703.33,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":940.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":940.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":940.59,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2152,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":1821,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":1382.52,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":940.59,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":940.59,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1358.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":716.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":1119.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":403.11,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":423.27,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":395.05,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":350.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":411.18,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":415.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":712,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":691.26,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":691.26,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":725.82,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":718.91,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":691.26,"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":1141.14,"maximum":1141.14,"gross_charge":1254,"discounted_cash":590.74,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1141.14,"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":294.57,"maximum":2152,"gross_charge":1254,"discounted_cash":590.74,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":790.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":790.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":790.02,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2152,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":1821,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":785.06,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":790.02,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":790.02,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1141.14,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":601.92,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":940.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":338.58,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":355.51,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":331.81,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":294.57,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":345.36,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":348.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":404.31,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":392.53,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":392.53,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":412.16,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":408.23,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":392.53,"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":1141.14,"maximum":1141.14,"gross_charge":1254,"discounted_cash":590.74,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1141.14,"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":294.57,"maximum":2152,"gross_charge":1254,"discounted_cash":590.74,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":790.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":790.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":790.02,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2152,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":1821,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":1382.52,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":790.02,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":790.02,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1141.14,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":601.92,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":940.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":338.58,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":355.51,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":331.81,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":294.57,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":345.36,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":348.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":712,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":691.26,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":691.26,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":725.82,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":718.91,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":691.26,"methodology":"case rate"}]}]},{"description":"EXC TR-EXT B9+MARG 2.1-3CM","code_information":[{"code":"11403","type":"CPT"}],"standard_charges":[{"minimum":691.26,"maximum":4157,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":4157,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3517,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":1382.52,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":712,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":691.26,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":691.26,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":725.82,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":718.91,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":691.26,"methodology":"case rate"}]}]},{"description":"EXC TR-EXT B9+MARG 3.1-4 CM","code_information":[{"code":"11404","type":"CPT"}],"standard_charges":[{"minimum":1538.38,"maximum":3183.7,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2152,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":1821,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":3183.7,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"median_amount":1947.5,"10th_percentile":1947.5,"90th_percentile":1947.5,"count":"1 through 10","methodology":"percent of total billed charges"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1639.61,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":1591.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1591.85,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":1671.44,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1655.52,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":1591.85,"methodology":"case rate"}]}]},{"description":"EXC TR-EXT B9+MARG >4.0 CM","code_information":[{"code":"11406","type":"CPT"}],"standard_charges":[{"minimum":1591.85,"maximum":3183.7,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2376,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":2011,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":3183.7,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"median_amount":1954.84,"10th_percentile":1954.84,"90th_percentile":1954.84,"count":"1 through 10","methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"median_amount":1954.84,"10th_percentile":1954.84,"90th_percentile":1954.84,"count":"1 through 10","methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1923.63,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_percentage":48,"median_amount":1968.81,"10th_percentile":1968.81,"90th_percentile":1968.81,"count":"1 through 10","methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"median_amount":1358.31,"10th_percentile":1358.31,"90th_percentile":1358.31,"count":"1 through 10","methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1639.61,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":1591.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1591.85,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":1671.44,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1655.52,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":1591.85,"methodology":"case rate"}]}]},{"description":"HC EXC BEN LES HAND/FEET .5CM","code_information":[{"code":"11420","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":1063.79,"maximum":1063.79,"gross_charge":1169,"discounted_cash":550.7,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1063.79,"methodology":"fee schedule"}]}]},{"description":"HC EXC BEN LES HAND/FEET .5CM","code_information":[{"code":"11420","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":274.6,"maximum":4157,"gross_charge":1169,"discounted_cash":550.7,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":736.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":736.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":736.47,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":4157,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3517,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":3183.7,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":736.47,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":736.47,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1063.79,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":561.12,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":876.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":315.63,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":331.42,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":309.32,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":274.6,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":321.95,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":325.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1639.61,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":1591.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1591.85,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":1671.44,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1655.52,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":1591.85,"methodology":"case rate"}]}]},{"description":"EXC H-F-NK-SP B9+MARG 0.6-1","code_information":[{"code":"11421","type":"CPT"}],"standard_charges":[{"minimum":691.26,"maximum":4157,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":4157,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3517,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":1382.52,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":712,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":691.26,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":691.26,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":725.82,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":718.91,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":691.26,"methodology":"case rate"}]}]},{"description":"EXC H-F-NK-SP B9+MARG 1.1-2","code_information":[{"code":"11422","type":"CPT"}],"standard_charges":[{"minimum":1538.38,"maximum":4157,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":4157,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3517,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":3183.7,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1639.61,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":1591.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1591.85,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":1671.44,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1655.52,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":1591.85,"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":1656.2,"maximum":1656.2,"gross_charge":1820,"discounted_cash":857.38,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1656.2,"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":427.52,"maximum":4157,"gross_charge":1820,"discounted_cash":857.38,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1146.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1146.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1146.6,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":4157,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3517,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":3183.7,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1146.6,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":1146.6,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1656.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":873.6,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":1365,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":491.4,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":515.97,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":481.58,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":427.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":501.23,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":506.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1639.61,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":1591.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1591.85,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":1671.44,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1655.52,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":1591.85,"methodology":"case rate"}]}]},{"description":"EXC H-F-NK-SP B9+MARG 3.1-4","code_information":[{"code":"11424","type":"CPT"}],"standard_charges":[{"minimum":1591.85,"maximum":3183.7,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2376,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":2011,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":3183.7,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1923.63,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1639.61,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":1591.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1591.85,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":1671.44,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1655.52,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":1591.85,"methodology":"case rate"}]}]},{"description":"EXC H-F-NK-SP B9+MARG >4 CM","code_information":[{"code":"11426","type":"CPT"}],"standard_charges":[{"minimum":1923.63,"maximum":5623.82,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2376,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":2011,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":5623.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1923.63,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2896.27,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":2811.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2811.91,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":2952.51,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2924.39,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":2811.91,"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":1358.63,"maximum":1358.63,"gross_charge":1493,"discounted_cash":703.33,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1358.63,"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":350.71,"maximum":2152,"gross_charge":1493,"discounted_cash":703.33,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":940.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":940.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":940.59,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2152,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":1821,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":1382.52,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":940.59,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":940.59,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1358.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":716.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":1119.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":403.11,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":423.27,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":395.05,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":350.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":411.18,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":415.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":712,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":691.26,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":691.26,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":725.82,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":718.91,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":691.26,"methodology":"case rate"}]}]},{"description":"EXC FACE-MM B9+MARG 0.6-1 CM","code_information":[{"code":"11441","type":"CPT"}],"standard_charges":[{"minimum":691.26,"maximum":2152,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2152,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":1821,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":1382.52,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":712,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":691.26,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":691.26,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":725.82,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":718.91,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":691.26,"methodology":"case rate"}]}]},{"description":"EXC FACE-MM B9+MARG 1.1-2 CM","code_information":[{"code":"11442","type":"CPT"}],"standard_charges":[{"minimum":691.26,"maximum":4157,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":4157,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3517,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":1382.52,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":712,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":691.26,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":691.26,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":725.82,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":718.91,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":691.26,"methodology":"case rate"}]}]},{"description":"EXC FACE-MM B9+MARG 2.1-3 CM","code_information":[{"code":"11443","type":"CPT"}],"standard_charges":[{"minimum":1538.38,"maximum":3183.7,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2376,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":2011,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":3183.7,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1639.61,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":1591.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1591.85,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":1671.44,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1655.52,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":1591.85,"methodology":"case rate"}]}]},{"description":"EXC FACE-MM B9+MARG 3.1-4 CM","code_information":[{"code":"11444","type":"CPT"}],"standard_charges":[{"minimum":1538.38,"maximum":3183.7,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2152,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":1821,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":3183.7,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1639.61,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":1591.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1591.85,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":1671.44,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1655.52,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":1591.85,"methodology":"case rate"}]}]},{"description":"EXC FACE-MM B9+MARG >4 CM","code_information":[{"code":"11446","type":"CPT"}],"standard_charges":[{"minimum":1923.63,"maximum":5623.82,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2376,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":2011,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":5623.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1923.63,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2896.27,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":2811.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2811.91,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":2952.51,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2924.39,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":2811.91,"methodology":"case rate"}]}]},{"description":"REMOVAL SWEAT GLAND LESION","code_information":[{"code":"11450","type":"CPT"}],"standard_charges":[{"minimum":1923.63,"maximum":5623.82,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2376,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":2011,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":5623.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1923.63,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2896.27,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":2811.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2811.91,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":2952.51,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2924.39,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":2811.91,"methodology":"case rate"}]}]},{"description":"REMOVAL SWEAT GLAND LESION","code_information":[{"code":"11451","type":"CPT"}],"standard_charges":[{"minimum":1923.63,"maximum":5623.82,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2376,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":2011,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":5623.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1923.63,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2896.27,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":2811.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2811.91,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":2952.51,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2924.39,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":2811.91,"methodology":"case rate"}]}]},{"description":"REMOVAL SWEAT GLAND LESION","code_information":[{"code":"11462","type":"CPT"}],"standard_charges":[{"minimum":1923.63,"maximum":5623.82,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2376,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":2011,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":5623.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1923.63,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"median_amount":1714.02,"10th_percentile":1714.02,"90th_percentile":1714.02,"count":"1 through 10","methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2896.27,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":2811.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2811.91,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":2952.51,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2924.39,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":2811.91,"methodology":"case rate"}]}]},{"description":"REMOVAL SWEAT GLAND LESION","code_information":[{"code":"11463","type":"CPT"}],"standard_charges":[{"minimum":1923.63,"maximum":5623.82,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2376,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":2011,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":5623.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1923.63,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2896.27,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":2811.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2811.91,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":2952.51,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2924.39,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":2811.91,"methodology":"case rate"}]}]},{"description":"REMOVAL SWEAT GLAND LESION","code_information":[{"code":"11470","type":"CPT"}],"standard_charges":[{"minimum":1923.63,"maximum":5623.82,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2376,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":2011,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":5623.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1923.63,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2896.27,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":2811.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2811.91,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":2952.51,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2924.39,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":2811.91,"methodology":"case rate"}]}]},{"description":"REMOVAL SWEAT GLAND LESION","code_information":[{"code":"11471","type":"CPT"}],"standard_charges":[{"minimum":1923.63,"maximum":5623.82,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2376,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":2011,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":5623.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1923.63,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2896.27,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":2811.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2811.91,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":2952.51,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2924.39,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":2811.91,"methodology":"case rate"}]}]},{"description":"EXTRAOCULAR PROCEDURES EXCEPT ORBIT","code_information":[{"code":"115","type":"MS-DRG"}],"standard_charges":[{"minimum":9501.6,"maximum":23052,"setting":"inpatient","payers_information":[{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":23052,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":20613,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":22225.94,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":19160,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":22656,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":20898,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":9501.6,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":11085.2,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":10557.33,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":10768.48,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":10768.48,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":10768.48,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":11446.36,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":11168.54,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":11112.97,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":11668.62,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":11390.8,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":11112.97,"methodology":"case rate"}]}]},{"description":"INTRAOCULAR PROCEDURES WITH CC/MCC","code_information":[{"code":"116","type":"MS-DRG"}],"standard_charges":[{"minimum":10329.22,"maximum":25124,"setting":"inpatient","payers_information":[{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":25124,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":22466,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":24161.9,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":20882,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":24692,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":22776,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":10329.22,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":12050.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":11476.91,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":11706.45,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":11706.45,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11706.45,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":12443.38,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":12141.36,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":12080.95,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":12685,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":12382.98,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":12080.95,"methodology":"case rate"}]}]},{"description":"EXC TR-EXT MAL+MARG 0.5 CM/<","code_information":[{"code":"11600","type":"CPT"}],"standard_charges":[{"minimum":691.26,"maximum":2376,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2376,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":2011,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":1382.52,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":712,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":691.26,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":691.26,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":725.82,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":718.91,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":691.26,"methodology":"case rate"}]}]},{"description":"EXC TR-EXT MAL+MARG 0.6-1 CM","code_information":[{"code":"11601","type":"CPT"}],"standard_charges":[{"minimum":691.26,"maximum":1538.38,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":1382.52,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":712,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":691.26,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":691.26,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":725.82,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":718.91,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":691.26,"methodology":"case rate"}]}]},{"description":"EXC TR-EXT MAL+MARG 1.1-2 CM","code_information":[{"code":"11602","type":"CPT"}],"standard_charges":[{"minimum":392.53,"maximum":2152,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2152,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":1821,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":785.06,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":404.31,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":392.53,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":392.53,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":412.16,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":408.23,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":392.53,"methodology":"case rate"}]}]},{"description":"EXC TR-EXT MAL+MARG 2.1-3 CM","code_information":[{"code":"11603","type":"CPT"}],"standard_charges":[{"minimum":691.26,"maximum":2376,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2376,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":2011,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":1382.52,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":712,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":691.26,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":691.26,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":725.82,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":718.91,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":691.26,"methodology":"case rate"}]}]},{"description":"EXC TR-EXT MAL+MARG 3.1-4 CM","code_information":[{"code":"11604","type":"CPT"}],"standard_charges":[{"minimum":691.26,"maximum":2376,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2376,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":2011,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":1382.52,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1923.63,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":712,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":691.26,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":691.26,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":725.82,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":718.91,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":691.26,"methodology":"case rate"}]}]},{"description":"EXC TR-EXT MAL+MARG >4 CM","code_information":[{"code":"11606","type":"CPT"}],"standard_charges":[{"minimum":1591.85,"maximum":3183.7,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2376,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":2011,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":3183.7,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1923.63,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1639.61,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":1591.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1591.85,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":1671.44,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1655.52,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":1591.85,"methodology":"case rate"}]}]},{"description":"EXC H-F-NK-SP MAL+MARG 0.5/<","code_information":[{"code":"11620","type":"CPT"}],"standard_charges":[{"minimum":1538.38,"maximum":3183.7,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":3183.7,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1639.61,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":1591.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1591.85,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":1671.44,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1655.52,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":1591.85,"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":610.61,"maximum":610.61,"gross_charge":671,"discounted_cash":316.1,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":610.61,"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":157.62,"maximum":2376,"gross_charge":671,"discounted_cash":316.1,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":422.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":422.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":422.73,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2376,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":2011,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":1382.52,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":422.73,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":422.73,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":610.61,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":322.08,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":503.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":181.17,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":190.23,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":177.55,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":157.62,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":184.8,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":186.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":712,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":691.26,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":691.26,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":725.82,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":718.91,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":691.26,"methodology":"case rate"}]}]},{"description":"EXC S/N/H/F/G MAL+MRG 1.1-2","code_information":[{"code":"11622","type":"CPT"}],"standard_charges":[{"minimum":691.26,"maximum":2376,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2376,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":2011,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":1382.52,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":712,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":691.26,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":691.26,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":725.82,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":718.91,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":691.26,"methodology":"case rate"}]}]},{"description":"EXC S/N/H/F/G MAL+MRG 2.1-3","code_information":[{"code":"11623","type":"CPT"}],"standard_charges":[{"minimum":1538.38,"maximum":3183.7,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2376,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":2011,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":3183.7,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1639.61,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":1591.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1591.85,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":1671.44,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1655.52,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":1591.85,"methodology":"case rate"}]}]},{"description":"EXC S/N/H/F/G MAL+MRG 3.1-4","code_information":[{"code":"11624","type":"CPT"}],"standard_charges":[{"minimum":1591.85,"maximum":3183.7,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2376,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":2011,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":3183.7,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1923.63,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1639.61,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":1591.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1591.85,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":1671.44,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1655.52,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":1591.85,"methodology":"case rate"}]}]},{"description":"EXC S/N/H/F/G MAL+MRG >4 CM","code_information":[{"code":"11626","type":"CPT"}],"standard_charges":[{"minimum":1923.63,"maximum":5623.82,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2376,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":2011,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":5623.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1923.63,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2896.27,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":2811.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2811.91,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":2952.51,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2924.39,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":2811.91,"methodology":"case rate"}]}]},{"description":"EXC F/E/E/N/L MAL+MRG 0.5CM<","code_information":[{"code":"11640","type":"CPT"}],"standard_charges":[{"minimum":691.26,"maximum":1538.38,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":1382.52,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":712,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":691.26,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":691.26,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":725.82,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":718.91,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":691.26,"methodology":"case rate"}]}]},{"description":"EXC F/E/E/N/L MAL+MRG 0.6-1","code_information":[{"code":"11641","type":"CPT"}],"standard_charges":[{"minimum":691.26,"maximum":1538.38,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":1382.52,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":712,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":691.26,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":691.26,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":725.82,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":718.91,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":691.26,"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":1769.04,"maximum":1769.04,"gross_charge":1944,"discounted_cash":915.79,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1769.04,"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":456.65,"maximum":1769.04,"gross_charge":1944,"discounted_cash":915.79,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1224.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1224.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1224.72,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":1382.52,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1224.72,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":1224.72,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1769.04,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":933.12,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":1458,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":524.88,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":551.13,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":514.39,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":456.65,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":535.38,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":540.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":712,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":691.26,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":691.26,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":725.82,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":718.91,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":691.26,"methodology":"case rate"}]}]},{"description":"EXC F/E/E/N/L MAL+MRG 2.1-3","code_information":[{"code":"11643","type":"CPT"}],"standard_charges":[{"minimum":1538.38,"maximum":3183.7,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2376,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":2011,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":3183.7,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1639.61,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":1591.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1591.85,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":1671.44,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1655.52,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":1591.85,"methodology":"case rate"}]}]},{"description":"EXC F/E/E/N/L MAL+MRG 3.1-4","code_information":[{"code":"11644","type":"CPT"}],"standard_charges":[{"minimum":1591.85,"maximum":3183.7,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2376,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":2011,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":3183.7,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1923.63,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1639.61,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":1591.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1591.85,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":1671.44,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1655.52,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":1591.85,"methodology":"case rate"}]}]},{"description":"EXC F/E/E/N/L MAL+MRG >4 CM","code_information":[{"code":"11646","type":"CPT"}],"standard_charges":[{"minimum":1923.63,"maximum":5623.82,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2376,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":2011,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":5623.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1923.63,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2896.27,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":2811.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2811.91,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":2952.51,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2924.39,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":2811.91,"methodology":"case rate"}]}]},{"description":"INTRAOCULAR PROCEDURES WITHOUT CC/MCC","code_information":[{"code":"117","type":"MS-DRG"}],"standard_charges":[{"minimum":6780.52,"maximum":16240,"setting":"inpatient","payers_information":[{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":16240,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":14522,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":15860.86,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":13498,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15961,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":14723,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":6780.52,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":7910.61,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":7533.91,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":7684.59,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":7684.59,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":7684.59,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":8168.35,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":7970.09,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7930.43,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":8326.96,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":8128.7,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":7930.43,"methodology":"case rate"}]}]},{"description":"HC TRIM NAILS ED","code_information":[{"code":"11719","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":122.85,"maximum":122.85,"gross_charge":135,"discounted_cash":63.6,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":122.85,"methodology":"fee schedule"}]}]},{"description":"HC TRIM NAILS ED","code_information":[{"code":"11719","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":31.72,"maximum":1538.38,"gross_charge":135,"discounted_cash":63.6,"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 - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":71.55,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":63.45,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":116.72,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":85.05,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":85.05,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":122.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":64.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":101.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":36.45,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":38.28,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.73,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":31.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":37.18,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":37.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":60.11,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":58.36,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":58.36,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":61.28,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":60.69,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":58.36,"methodology":"case rate"}]}]},{"description":"HC DEBRIDE NAIL 1-5","code_information":[{"code":"11720","type":"CPT"},{"code":"0761","type":"RC"}],"standard_charges":[{"minimum":364.91,"maximum":364.91,"gross_charge":401,"discounted_cash":188.91,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":364.91,"methodology":"fee schedule"}]}]},{"description":"HC DEBRIDE NAIL 1-5","code_information":[{"code":"11720","type":"CPT"},{"code":"0761","type":"RC"}],"standard_charges":[{"minimum":58.36,"maximum":1538.38,"gross_charge":401,"discounted_cash":188.91,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":252.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":252.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":252.63,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":116.72,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":252.63,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":252.63,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":364.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":192.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":300.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":108.27,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":113.69,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":106.11,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":94.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":110.44,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":111.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":60.11,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":58.36,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":58.36,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":61.28,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":60.69,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":58.36,"methodology":"case rate"}]}]},{"description":"HC DEBRIDE NAIL 6 OR >","code_information":[{"code":"11721","type":"CPT"},{"code":"0761","type":"RC"}],"standard_charges":[{"minimum":364.91,"maximum":364.91,"gross_charge":401,"discounted_cash":188.91,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":364.91,"methodology":"fee schedule"}]}]},{"description":"HC DEBRIDE NAIL 6 OR >","code_information":[{"code":"11721","type":"CPT"},{"code":"0761","type":"RC"}],"standard_charges":[{"minimum":58.36,"maximum":1538.38,"gross_charge":401,"discounted_cash":188.91,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":252.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":252.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":252.63,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":116.72,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":252.63,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":252.63,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":364.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":192.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":300.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":108.27,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":113.69,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":106.11,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":94.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":110.44,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":111.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":60.11,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":58.36,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":58.36,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":61.28,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":60.69,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":58.36,"methodology":"case rate"}]}]},{"description":"HC AVULSION OF SGL NAIL PLATE","code_information":[{"code":"11730","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":409.5,"maximum":409.5,"gross_charge":450,"discounted_cash":211.99,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":409.5,"methodology":"fee schedule"}]}]},{"description":"HC AVULSION OF SGL NAIL PLATE","code_information":[{"code":"11730","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":105.71,"maximum":2152,"gross_charge":450,"discounted_cash":211.99,"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 - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2152,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":1821,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":390.44,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":283.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":283.5,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":409.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":216,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":337.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":121.5,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":127.58,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":119.07,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":105.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":123.93,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":125.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":201.08,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":195.22,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":195.22,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":204.98,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":203.03,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":195.22,"methodology":"case rate"}]}]},{"description":"HC NAIL PLATE SIMPLE ADDL","code_information":[{"code":"11732","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":278.46,"maximum":278.46,"gross_charge":306,"discounted_cash":144.16,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":278.46,"methodology":"fee schedule"}]}]},{"description":"HC NAIL PLATE SIMPLE ADDL","code_information":[{"code":"11732","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":71.88,"maximum":1538.38,"gross_charge":306,"discounted_cash":144.16,"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":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":192.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":192.78,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":278.46,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":146.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":229.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":82.62,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":86.76,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":80.97,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":71.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":84.28,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":85.1,"methodology":"fee schedule"}]}]},{"description":"HC EVAC SUBUNGUAL HEMATOMA","code_information":[{"code":"11740","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":208.39,"maximum":208.39,"gross_charge":229,"discounted_cash":107.88,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":208.39,"methodology":"fee schedule"}]}]},{"description":"HC EVAC SUBUNGUAL HEMATOMA","code_information":[{"code":"11740","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":53.8,"maximum":1538.38,"gross_charge":229,"discounted_cash":107.88,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":144.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":144.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":144.27,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":121.37,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":107.63,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":253.28,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":144.27,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":144.27,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":208.39,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":109.92,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":171.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":61.83,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":64.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":60.6,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":53.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":63.07,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":63.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":130.44,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":126.64,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":126.64,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":132.97,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":131.71,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":126.64,"methodology":"case rate"}]}]},{"description":"HC REMOVAL OF NAIL BED","code_information":[{"code":"11750","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":906.36,"maximum":906.36,"gross_charge":996,"discounted_cash":469.2,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":906.36,"methodology":"fee schedule"}]}]},{"description":"HC REMOVAL OF NAIL BED","code_information":[{"code":"11750","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":233.97,"maximum":2152,"gross_charge":996,"discounted_cash":469.2,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":627.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":627.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":627.48,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2152,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":1821,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":785.06,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":627.48,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":627.48,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":906.36,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":478.08,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":747,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":268.92,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":282.37,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":263.55,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":233.97,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":274.3,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":276.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":404.31,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":392.53,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":392.53,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":412.16,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":408.23,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":392.53,"methodology":"case rate"}]}]},{"description":"BIOPSY NAIL UNIT","code_information":[{"code":"11755","type":"CPT"}],"standard_charges":[{"minimum":691.26,"maximum":2152,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2152,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":1821,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":1382.52,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":712,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":691.26,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":691.26,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":725.82,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":718.91,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":691.26,"methodology":"case rate"}]}]},{"description":"HC REPAIR NAIL BED","code_information":[{"code":"11760","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":559.65,"maximum":559.65,"gross_charge":615,"discounted_cash":289.72,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":559.65,"methodology":"fee schedule"}]}]},{"description":"HC REPAIR NAIL BED","code_information":[{"code":"11760","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":144.47,"maximum":1538.38,"gross_charge":615,"discounted_cash":289.72,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":387.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":387.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":387.45,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":325.95,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":289.05,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":1202.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":387.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":387.45,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":559.65,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":295.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":461.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":166.05,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":174.36,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":162.73,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":144.47,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":169.38,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":171.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":619.45,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":601.41,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":601.41,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":631.48,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":625.47,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":601.41,"methodology":"case rate"}]}]},{"description":"HC RECONSTRUC OF NAIL BED W GRAFT","code_information":[{"code":"11762","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":376.74,"maximum":376.74,"gross_charge":414,"discounted_cash":195.03,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":376.74,"methodology":"fee schedule"}]}]},{"description":"HC RECONSTRUC OF NAIL BED W GRAFT","code_information":[{"code":"11762","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":97.25,"maximum":3594.36,"gross_charge":414,"discounted_cash":195.03,"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 - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2376,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":2011,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":3594.36,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":260.82,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":260.82,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":376.74,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":198.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":310.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":111.78,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":117.37,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":109.55,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":97.25,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":114.02,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":115.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1851.1,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":1797.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1797.18,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":1887.04,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1869.07,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":1797.18,"methodology":"case rate"}]}]},{"description":"HC WEDGE EXC NAIL FOLD","code_information":[{"code":"11765","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":427.7,"maximum":427.7,"gross_charge":470,"discounted_cash":221.41,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":427.7,"methodology":"fee schedule"}]}]},{"description":"HC WEDGE EXC NAIL FOLD","code_information":[{"code":"11765","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":110.41,"maximum":2152,"gross_charge":470,"discounted_cash":221.41,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":296.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":296.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":296.1,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2152,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":1821,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":785.06,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":296.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":296.1,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":427.7,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":225.6,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":352.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":126.9,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":133.25,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":124.37,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":110.41,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":129.44,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":130.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":404.31,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":392.53,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":392.53,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":412.16,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":408.23,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":392.53,"methodology":"case rate"}]}]},{"description":"REMOVE PILONIDAL CYST SIMPLE","code_information":[{"code":"11770","type":"CPT"}],"standard_charges":[{"minimum":2657.78,"maximum":5623.82,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":3796,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3212,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":5623.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":2657.78,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"median_amount":2794.43,"10th_percentile":2794.43,"90th_percentile":2794.43,"count":"1 through 10","methodology":"percent of total billed charges"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"median_amount":1783.71,"10th_percentile":1783.71,"90th_percentile":1783.71,"count":"1 through 10","methodology":"percent of total billed charges"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2896.27,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":2811.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2811.91,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":2952.51,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2924.39,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":2811.91,"methodology":"case rate"}]}]},{"description":"REMOVE PILONIDAL CYST EXTEN","code_information":[{"code":"11771","type":"CPT"}],"standard_charges":[{"minimum":2657.78,"maximum":5623.82,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":3796,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3212,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":5623.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":2657.78,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2896.27,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":2811.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2811.91,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":2952.51,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2924.39,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":2811.91,"methodology":"case rate"}]}]},{"description":"REMOVE PILONIDAL CYST COMPL","code_information":[{"code":"11772","type":"CPT"}],"standard_charges":[{"minimum":2657.78,"maximum":5623.82,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":3796,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3212,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":5623.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":2657.78,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_percentage":48,"median_amount":3171.86,"10th_percentile":3171.86,"90th_percentile":3171.86,"count":"1 through 10","methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"median_amount":2518.22,"10th_percentile":1461.82,"90th_percentile":2518.22,"count":"1 through 10","methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2896.27,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":2811.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2811.91,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":2952.51,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2924.39,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":2811.91,"methodology":"case rate"}]}]},{"description":"INJECT SKIN LESIONS </W 7","code_information":[{"code":"11900","type":"CPT"}],"standard_charges":[{"minimum":195.22,"maximum":1538.38,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":390.44,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":201.08,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":195.22,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":195.22,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":204.98,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":203.03,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":195.22,"methodology":"case rate"}]}]},{"description":"INJECT SKIN LESIONS >7","code_information":[{"code":"11901","type":"CPT"}],"standard_charges":[{"minimum":195.22,"maximum":1538.38,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":390.44,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":201.08,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":195.22,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":195.22,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":204.98,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":203.03,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":195.22,"methodology":"case rate"}]}]},{"description":"CORRECT SKIN COLOR 6.0 CM/<","code_information":[{"code":"11920","type":"CPT"}],"standard_charges":[{"minimum":601.41,"maximum":1538.38,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":1202.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":619.45,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":601.41,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":601.41,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":631.48,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":625.47,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":601.41,"methodology":"case rate"}]}]},{"description":"CORRECT SKN COLOR 6.1-20.0CM","code_information":[{"code":"11921","type":"CPT"}],"standard_charges":[{"minimum":601.41,"maximum":1538.38,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":1202.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":619.45,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":601.41,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":601.41,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":631.48,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":625.47,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":601.41,"methodology":"case rate"}]}]},{"description":"CORRECT SKIN COLOR EA 20.0CM","code_information":[{"code":"11922","type":"CPT"}],"standard_charges":[{"minimum":1538.38,"maximum":1538.38,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"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|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"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":195.22,"maximum":1538.38,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":390.44,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":201.08,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":195.22,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":195.22,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":204.98,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":203.03,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":195.22,"methodology":"case rate"}]}]},{"description":"TX CONTOUR DEFECTS 1.1-5.0CC","code_information":[{"code":"11951","type":"CPT"}],"standard_charges":[{"minimum":601.41,"maximum":1538.38,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":1202.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":619.45,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":601.41,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":601.41,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":631.48,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":625.47,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":601.41,"methodology":"case rate"}]}]},{"description":"TX CONTOUR DEFECTS 5.1-10CC","code_information":[{"code":"11952","type":"CPT"}],"standard_charges":[{"minimum":601.41,"maximum":1538.38,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":1202.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":619.45,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":601.41,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":601.41,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":631.48,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":625.47,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":601.41,"methodology":"case rate"}]}]},{"description":"TX CONTOUR DEFECTS >10.0 CC","code_information":[{"code":"11954","type":"CPT"}],"standard_charges":[{"minimum":601.41,"maximum":1538.38,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":1202.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":619.45,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":601.41,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":601.41,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":631.48,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":625.47,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":601.41,"methodology":"case rate"}]}]},{"description":"INSERT TISSUE EXPANDER(S)","code_information":[{"code":"11960","type":"CPT"}],"standard_charges":[{"minimum":1923.63,"maximum":7193.66,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2376,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":2011,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":7193.66,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1923.63,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3704.73,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":3596.83,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3596.83,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":3776.67,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3740.7,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":3596.83,"methodology":"case rate"}]}]},{"description":"REPLACE TISSUE EXPANDER","code_information":[{"code":"11970","type":"CPT"}],"standard_charges":[{"minimum":2657.78,"maximum":14037.14,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":3796,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3212,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":14037.14,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"median_amount":3774.31,"10th_percentile":3243.21,"90th_percentile":3774.31,"count":"1 through 10","methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"median_amount":3774.31,"10th_percentile":3243.21,"90th_percentile":3774.31,"count":"1 through 10","methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2657.78,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_percentage":48,"median_amount":13798.08,"10th_percentile":13798.08,"90th_percentile":13798.08,"count":"1 through 10","methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"median_amount":1691.13,"10th_percentile":1691.13,"90th_percentile":1691.13,"count":"1 through 10","methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":7229.13,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":7369.5,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7299.31,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"}]}]},{"description":"REMOVE TISSUE EXPANDER(S)","code_information":[{"code":"11971","type":"CPT"}],"standard_charges":[{"minimum":1538.38,"maximum":5623.82,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2152,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":1821,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":5623.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2896.27,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":2811.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2811.91,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":2952.51,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2924.39,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":2811.91,"methodology":"case rate"}]}]},{"description":"REMOVE CONTRACEPTIVE CAPSULE","code_information":[{"code":"11976","type":"CPT"}],"standard_charges":[{"minimum":691.26,"maximum":1538.38,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":1382.52,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":712,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":691.26,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":691.26,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":725.82,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":718.91,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":691.26,"methodology":"case rate"}]}]},{"description":"IMPLANT HORMONE PELLET(S)","code_information":[{"code":"11980","type":"CPT"}],"standard_charges":[{"minimum":392.05,"maximum":1538.38,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":784.1,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":403.81,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":392.05,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":392.05,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":411.65,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":407.73,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":392.05,"methodology":"case rate"}]}]},{"description":"INSERT DRUG IMPLANT DEVICE","code_information":[{"code":"11981","type":"CPT"}],"standard_charges":[{"minimum":126.64,"maximum":2152,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2152,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":1821,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":253.28,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":130.44,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":126.64,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":126.64,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":132.97,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":131.71,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":126.64,"methodology":"case rate"}]}]},{"description":"HC REMOVAL OF DRUG IMPLANT DEVICE","code_information":[{"code":"11982","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":235.69,"maximum":235.69,"gross_charge":259,"discounted_cash":122.02,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":235.69,"methodology":"fee schedule"}]}]},{"description":"HC REMOVAL OF DRUG IMPLANT DEVICE","code_information":[{"code":"11982","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":60.84,"maximum":2152,"gross_charge":259,"discounted_cash":122.02,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":163.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":163.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":163.17,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2152,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":1821,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":784.1,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":163.17,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":163.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":235.69,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":124.32,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":194.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":69.93,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":73.43,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":68.54,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":60.84,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":71.33,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":72.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":403.81,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":392.05,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":392.05,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":411.65,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":407.73,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":392.05,"methodology":"case rate"}]}]},{"description":"REMOVE/INSERT DRUG IMPLANT","code_information":[{"code":"11983","type":"CPT"}],"standard_charges":[{"minimum":392.05,"maximum":2152,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2152,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":1821,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":784.1,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":403.81,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":392.05,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":392.05,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":411.65,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":407.73,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":392.05,"methodology":"case rate"}]}]},{"description":"HC REPAIR SIMSCLP 2.5CM/<","code_information":[{"code":"12001","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":803.53,"maximum":803.53,"gross_charge":883,"discounted_cash":415.97,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":803.53,"methodology":"fee schedule"}]}]},{"description":"HC REPAIR SIMSCLP 2.5CM/<","code_information":[{"code":"12001","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":195.22,"maximum":1538.38,"gross_charge":883,"discounted_cash":415.97,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":556.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":556.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":556.29,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":467.99,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":415.01,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":390.44,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":556.29,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":556.29,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":803.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":423.84,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":662.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":238.41,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":250.34,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":233.65,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":207.42,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":243.18,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":245.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":201.08,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":195.22,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":195.22,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":204.98,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":203.03,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":195.22,"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":843.57,"maximum":843.57,"gross_charge":927,"discounted_cash":436.7,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":843.57,"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":195.22,"maximum":1538.38,"gross_charge":927,"discounted_cash":436.7,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":584.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":584.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":584.01,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":491.31,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":435.69,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":390.44,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":584.01,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":584.01,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":843.57,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":444.96,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":695.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":250.29,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":262.81,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":245.29,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":217.76,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":255.3,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":257.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":201.08,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":195.22,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":195.22,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":204.98,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":203.03,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":195.22,"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":811.72,"maximum":811.72,"gross_charge":892,"discounted_cash":420.21,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":811.72,"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":195.22,"maximum":1538.38,"gross_charge":892,"discounted_cash":420.21,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":561.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":561.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":561.96,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":472.76,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":419.24,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":390.44,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":561.96,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":561.96,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":811.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":428.16,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":669,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":240.84,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":252.89,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":236.03,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":209.54,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":245.66,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":248.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":201.08,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":195.22,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":195.22,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":204.98,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":203.03,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":195.22,"methodology":"case rate"}]}]},{"description":"HC REPAIR SIM SCLP 12.6-20CM","code_information":[{"code":"12005","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":811.72,"maximum":811.72,"gross_charge":892,"discounted_cash":420.21,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":811.72,"methodology":"fee schedule"}]}]},{"description":"HC REPAIR SIM SCLP 12.6-20CM","code_information":[{"code":"12005","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":209.54,"maximum":2376,"gross_charge":892,"discounted_cash":420.21,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":561.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":561.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":561.96,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2376,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":2011,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":785.06,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":561.96,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":561.96,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1923.63,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":811.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":428.16,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":669,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":240.84,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":252.89,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":236.03,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":209.54,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":245.66,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":248.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":404.31,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":392.53,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":392.53,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":412.16,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":408.23,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":392.53,"methodology":"case rate"}]}]},{"description":"HC REPAIR SIM SCLP 20.1-30CM","code_information":[{"code":"12006","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":803.53,"maximum":803.53,"gross_charge":883,"discounted_cash":415.97,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":803.53,"methodology":"fee schedule"}]}]},{"description":"HC REPAIR SIM SCLP 20.1-30CM","code_information":[{"code":"12006","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":207.42,"maximum":2376,"gross_charge":883,"discounted_cash":415.97,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":556.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":556.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":556.29,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2376,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":2011,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":785.06,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":556.29,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":556.29,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1923.63,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":803.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":423.84,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":662.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":238.41,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":250.34,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":233.65,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":207.42,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":243.18,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":245.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":404.31,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":392.53,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":392.53,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":412.16,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":408.23,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":392.53,"methodology":"case rate"}]}]},{"description":"HC REPAIR SIM SCLP>30CM","code_information":[{"code":"12007","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":819.91,"maximum":819.91,"gross_charge":901,"discounted_cash":424.45,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":819.91,"methodology":"fee schedule"}]}]},{"description":"HC REPAIR SIM SCLP>30CM","code_information":[{"code":"12007","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":195.22,"maximum":2376,"gross_charge":901,"discounted_cash":424.45,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":567.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":567.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":567.63,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2376,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":2011,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":390.44,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":567.63,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":567.63,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1923.63,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":819.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":432.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":675.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":243.27,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":255.44,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":238.41,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":211.65,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":248.14,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":250.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":201.08,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":195.22,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":195.22,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":204.98,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":203.03,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":195.22,"methodology":"case rate"}]}]},{"description":"HC REPAIR SIM FACE 2.5CM/<","code_information":[{"code":"12011","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":803.53,"maximum":803.53,"gross_charge":883,"discounted_cash":415.97,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":803.53,"methodology":"fee schedule"}]}]},{"description":"HC REPAIR SIM FACE 2.5CM/<","code_information":[{"code":"12011","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":195.22,"maximum":1538.38,"gross_charge":883,"discounted_cash":415.97,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":556.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":556.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":556.29,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":467.99,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":415.01,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":390.44,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":556.29,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":556.29,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":803.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":423.84,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":662.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":238.41,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":250.34,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":233.65,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":207.42,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":243.18,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":245.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":201.08,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":195.22,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":195.22,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":204.98,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":203.03,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":195.22,"methodology":"case rate"}]}]},{"description":"HC REPAIR SIM FACE 2.6-5CM","code_information":[{"code":"12013","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":803.53,"maximum":803.53,"gross_charge":883,"discounted_cash":415.97,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":803.53,"methodology":"fee schedule"}]}]},{"description":"HC REPAIR SIM FACE 2.6-5CM","code_information":[{"code":"12013","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":195.22,"maximum":1538.38,"gross_charge":883,"discounted_cash":415.97,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":556.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":556.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":556.29,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":467.99,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":415.01,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":390.44,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":556.29,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":556.29,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":803.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":423.84,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":662.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":238.41,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":250.34,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":233.65,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":207.42,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":243.18,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":245.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":201.08,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":195.22,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":195.22,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":204.98,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":203.03,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":195.22,"methodology":"case rate"}]}]},{"description":"HC REPAIR SIM FACE 5.1-7.5CM","code_information":[{"code":"12014","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":803.53,"maximum":803.53,"gross_charge":883,"discounted_cash":415.97,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":803.53,"methodology":"fee schedule"}]}]},{"description":"HC REPAIR SIM FACE 5.1-7.5CM","code_information":[{"code":"12014","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":195.22,"maximum":1538.38,"gross_charge":883,"discounted_cash":415.97,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":556.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":556.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":556.29,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":467.99,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":415.01,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":390.44,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":556.29,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":556.29,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":803.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":423.84,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":662.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":238.41,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":250.34,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":233.65,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":207.42,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":243.18,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":245.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":201.08,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":195.22,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":195.22,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":204.98,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":203.03,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":195.22,"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":803.53,"maximum":803.53,"gross_charge":883,"discounted_cash":415.97,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":803.53,"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":195.22,"maximum":1538.38,"gross_charge":883,"discounted_cash":415.97,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":556.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":556.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":556.29,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":467.99,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":415.01,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":390.44,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":556.29,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":556.29,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":803.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":423.84,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":662.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":238.41,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":250.34,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":233.65,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":207.42,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":243.18,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":245.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":201.08,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":195.22,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":195.22,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":204.98,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":203.03,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":195.22,"methodology":"case rate"}]}]},{"description":"HC REPAIR SIM FACE 12.6-20CM","code_information":[{"code":"12016","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":803.53,"maximum":803.53,"gross_charge":883,"discounted_cash":415.97,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":803.53,"methodology":"fee schedule"}]}]},{"description":"HC REPAIR SIM FACE 12.6-20CM","code_information":[{"code":"12016","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":207.42,"maximum":2376,"gross_charge":883,"discounted_cash":415.97,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":556.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":556.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":556.29,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2376,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":2011,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":785.06,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":556.29,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":556.29,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1923.63,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":803.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":423.84,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":662.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":238.41,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":250.34,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":233.65,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":207.42,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":243.18,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":245.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":404.31,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":392.53,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":392.53,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":412.16,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":408.23,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":392.53,"methodology":"case rate"}]}]},{"description":"HC RESUPERF WND FACE 20.1-30 CM","code_information":[{"code":"12017","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":803.53,"maximum":803.53,"gross_charge":883,"discounted_cash":415.97,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":803.53,"methodology":"fee schedule"}]}]},{"description":"HC RESUPERF WND FACE 20.1-30 CM","code_information":[{"code":"12017","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":207.42,"maximum":2376,"gross_charge":883,"discounted_cash":415.97,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":556.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":556.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":556.29,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2376,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":2011,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":785.06,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":556.29,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":556.29,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1923.63,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":803.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":423.84,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":662.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":238.41,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":250.34,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":233.65,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":207.42,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":243.18,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":245.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":404.31,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":392.53,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":392.53,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":412.16,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":408.23,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":392.53,"methodology":"case rate"}]}]},{"description":"HC RESUPERF WND FACE >30 CM","code_information":[{"code":"12018","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":803.53,"maximum":803.53,"gross_charge":883,"discounted_cash":415.97,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":803.53,"methodology":"fee schedule"}]}]},{"description":"HC RESUPERF WND FACE >30 CM","code_information":[{"code":"12018","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":195.22,"maximum":2376,"gross_charge":883,"discounted_cash":415.97,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":556.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":556.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":556.29,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2376,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":2011,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":390.44,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":556.29,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":556.29,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1923.63,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":803.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":423.84,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":662.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":238.41,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":250.34,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":233.65,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":207.42,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":243.18,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":245.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":201.08,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":195.22,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":195.22,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":204.98,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":203.03,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":195.22,"methodology":"case rate"}]}]},{"description":"HC REPAIR SIM WND DEHISC","code_information":[{"code":"12020","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":573.3,"maximum":573.3,"gross_charge":630,"discounted_cash":296.79,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":573.3,"methodology":"fee schedule"}]}]},{"description":"HC REPAIR SIM WND DEHISC","code_information":[{"code":"12020","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":147.99,"maximum":2152,"gross_charge":630,"discounted_cash":296.79,"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 - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2152,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":1821,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":1202.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":396.9,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":396.9,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":573.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":302.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":472.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":170.1,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":178.61,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":166.7,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":147.99,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":173.51,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":175.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":619.45,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":601.41,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":601.41,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":631.48,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":625.47,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":601.41,"methodology":"case rate"}]}]},{"description":"HC REPAIR SIM WND DEHIS W PACK","code_information":[{"code":"12021","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":573.3,"maximum":573.3,"gross_charge":630,"discounted_cash":296.79,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":573.3,"methodology":"fee schedule"}]}]},{"description":"HC REPAIR SIM WND DEHIS W PACK","code_information":[{"code":"12021","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":147.99,"maximum":2152,"gross_charge":630,"discounted_cash":296.79,"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 - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2152,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":1821,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":785.06,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":396.9,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":396.9,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":573.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":302.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":472.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":170.1,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":178.61,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":166.7,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":147.99,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":173.51,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":175.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":404.31,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":392.53,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":392.53,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":412.16,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":408.23,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":392.53,"methodology":"case rate"}]}]},{"description":"HC REPAIR INT SCLP 2.5CM /<","code_information":[{"code":"12031","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":710.71,"maximum":710.71,"gross_charge":781,"discounted_cash":367.92,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":710.71,"methodology":"fee schedule"}]}]},{"description":"HC REPAIR INT SCLP 2.5CM /<","code_information":[{"code":"12031","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":183.46,"maximum":1538.38,"gross_charge":781,"discounted_cash":367.92,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":492.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":492.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":492.03,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":413.93,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":367.07,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":785.06,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":492.03,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":492.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":710.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":374.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":585.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":210.87,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":221.42,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":206.66,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":183.46,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":215.09,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":217.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":404.31,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":392.53,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":392.53,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":412.16,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":408.23,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":392.53,"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":717.99,"maximum":717.99,"gross_charge":789,"discounted_cash":371.69,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":717.99,"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":185.34,"maximum":1538.38,"gross_charge":789,"discounted_cash":371.69,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":497.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":497.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":497.07,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":418.17,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":370.83,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":785.06,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":497.07,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":497.07,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":717.99,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":378.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":591.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":213.03,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":223.69,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":208.77,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":185.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":217.3,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":219.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":404.31,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":392.53,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":392.53,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":412.16,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":408.23,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":392.53,"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":717.99,"maximum":717.99,"gross_charge":789,"discounted_cash":371.69,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":717.99,"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":185.34,"maximum":2376,"gross_charge":789,"discounted_cash":371.69,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":497.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":497.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":497.07,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2376,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":2011,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":785.06,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":497.07,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":497.07,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1923.63,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":717.99,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":378.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":591.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":213.03,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":223.69,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":208.77,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":185.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":217.3,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":219.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":404.31,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":392.53,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":392.53,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":412.16,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":408.23,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":392.53,"methodology":"case rate"}]}]},{"description":"HC REPAIR INT SCLP 12.6-20CM","code_information":[{"code":"12035","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":904.54,"maximum":904.54,"gross_charge":994,"discounted_cash":468.26,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":904.54,"methodology":"fee schedule"}]}]},{"description":"HC REPAIR INT SCLP 12.6-20CM","code_information":[{"code":"12035","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":233.5,"maximum":2376,"gross_charge":994,"discounted_cash":468.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":626.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":626.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":626.22,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2376,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":2011,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":785.06,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":626.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":626.22,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1923.63,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":904.54,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":477.12,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":745.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":268.38,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":281.8,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":263.02,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":233.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":273.75,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":276.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":404.31,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":392.53,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":392.53,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":412.16,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":408.23,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":392.53,"methodology":"case rate"}]}]},{"description":"HC REPAIR INT SCLP 20.1-30CM","code_information":[{"code":"12036","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":904.54,"maximum":904.54,"gross_charge":994,"discounted_cash":468.26,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":904.54,"methodology":"fee schedule"}]}]},{"description":"HC REPAIR INT SCLP 20.1-30CM","code_information":[{"code":"12036","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":233.5,"maximum":2376,"gross_charge":994,"discounted_cash":468.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":626.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":626.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":626.22,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2376,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":2011,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":1202.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":626.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":626.22,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1923.63,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":904.54,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":477.12,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":745.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":268.38,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":281.8,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":263.02,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":233.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":273.75,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":276.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":619.45,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":601.41,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":601.41,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":631.48,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":625.47,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":601.41,"methodology":"case rate"}]}]},{"description":"HC REPAIR INT WND S/TR/EXT 30.0+CM","code_information":[{"code":"12037","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":904.54,"maximum":904.54,"gross_charge":994,"discounted_cash":468.26,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":904.54,"methodology":"fee schedule"}]}]},{"description":"HC REPAIR INT WND S/TR/EXT 30.0+CM","code_information":[{"code":"12037","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":233.5,"maximum":3594.36,"gross_charge":994,"discounted_cash":468.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":626.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":626.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":626.22,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2376,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":2011,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":3594.36,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":626.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":626.22,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1923.63,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":904.54,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":477.12,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":745.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":268.38,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":281.8,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":263.02,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":233.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":273.75,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":276.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1851.1,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":1797.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1797.18,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":1887.04,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1869.07,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":1797.18,"methodology":"case rate"}]}]},{"description":"HC REPAIR INT N-HF/GN <2.5CM/<","code_information":[{"code":"12041","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":823.55,"maximum":823.55,"gross_charge":905,"discounted_cash":426.34,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":823.55,"methodology":"fee schedule"}]}]},{"description":"HC REPAIR INT N-HF/GN <2.5CM/<","code_information":[{"code":"12041","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":212.59,"maximum":1538.38,"gross_charge":905,"discounted_cash":426.34,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":570.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":570.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":570.15,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":479.65,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":425.35,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":785.06,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":570.15,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":570.15,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":823.55,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":434.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":678.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":244.35,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":256.57,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":239.47,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":212.59,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":249.24,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":251.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":404.31,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":392.53,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":392.53,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":412.16,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":408.23,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":392.53,"methodology":"case rate"}]}]},{"description":"HC REPAIR INT N-HF/GN2.6-7.5CM","code_information":[{"code":"12042","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":831.74,"maximum":831.74,"gross_charge":914,"discounted_cash":430.57,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":831.74,"methodology":"fee schedule"}]}]},{"description":"HC REPAIR INT N-HF/GN2.6-7.5CM","code_information":[{"code":"12042","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":214.7,"maximum":1538.38,"gross_charge":914,"discounted_cash":430.57,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":575.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":575.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":575.82,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":484.42,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":429.58,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":785.06,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":575.82,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":575.82,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":831.74,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":438.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":685.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":246.78,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":259.12,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":241.85,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":214.7,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":251.72,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":254.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":404.31,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":392.53,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":392.53,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":412.16,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":408.23,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":392.53,"methodology":"case rate"}]}]},{"description":"HC REPAIR INT N-HF/GN7.6-12.5CM","code_information":[{"code":"12044","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":823.55,"maximum":823.55,"gross_charge":905,"discounted_cash":426.34,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":823.55,"methodology":"fee schedule"}]}]},{"description":"HC REPAIR INT N-HF/GN7.6-12.5CM","code_information":[{"code":"12044","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":212.59,"maximum":2376,"gross_charge":905,"discounted_cash":426.34,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":570.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":570.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":570.15,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2376,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":2011,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":1202.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":570.15,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":570.15,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1923.63,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":823.55,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":434.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":678.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":244.35,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":256.57,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":239.47,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":212.59,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":249.24,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":251.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":619.45,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":601.41,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":601.41,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":631.48,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":625.47,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":601.41,"methodology":"case rate"}]}]},{"description":"HC REPAIR INT N-HF/GN12.6-20CM","code_information":[{"code":"12045","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":823.55,"maximum":823.55,"gross_charge":905,"discounted_cash":426.34,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":823.55,"methodology":"fee schedule"}]}]},{"description":"HC REPAIR INT N-HF/GN12.6-20CM","code_information":[{"code":"12045","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":212.59,"maximum":2376,"gross_charge":905,"discounted_cash":426.34,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":570.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":570.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":570.15,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2376,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":2011,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":1202.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":570.15,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":570.15,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1923.63,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":823.55,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":434.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":678.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":244.35,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":256.57,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":239.47,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":212.59,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":249.24,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":251.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":619.45,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":601.41,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":601.41,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":631.48,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":625.47,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":601.41,"methodology":"case rate"}]}]},{"description":"HC LAYR CLOS WND REST BODY 20.1-30 CM","code_information":[{"code":"12046","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":823.55,"maximum":823.55,"gross_charge":905,"discounted_cash":426.34,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":823.55,"methodology":"fee schedule"}]}]},{"description":"HC LAYR CLOS WND REST BODY 20.1-30 CM","code_information":[{"code":"12046","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":212.59,"maximum":2376,"gross_charge":905,"discounted_cash":426.34,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":570.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":570.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":570.15,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2376,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":2011,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":1202.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":570.15,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":570.15,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1923.63,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":823.55,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":434.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":678.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":244.35,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":256.57,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":239.47,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":212.59,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":249.24,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":251.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":619.45,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":601.41,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":601.41,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":631.48,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":625.47,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":601.41,"methodology":"case rate"}]}]},{"description":"HC LAYR CLOS WND REST BODY >30 CM","code_information":[{"code":"12047","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":823.55,"maximum":823.55,"gross_charge":905,"discounted_cash":426.34,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":823.55,"methodology":"fee schedule"}]}]},{"description":"HC LAYR CLOS WND REST BODY >30 CM","code_information":[{"code":"12047","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":212.59,"maximum":3594.36,"gross_charge":905,"discounted_cash":426.34,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":570.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":570.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":570.15,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2376,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":2011,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":3594.36,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":570.15,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":570.15,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1923.63,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":823.55,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":434.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":678.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":244.35,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":256.57,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":239.47,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":212.59,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":249.24,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":251.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1851.1,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":1797.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1797.18,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":1887.04,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1869.07,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":1797.18,"methodology":"case rate"}]}]},{"description":"HC REPAIR INT FACE 2.5CM/<","code_information":[{"code":"12051","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":1152.97,"maximum":1152.97,"gross_charge":1267,"discounted_cash":596.87,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1152.97,"methodology":"fee schedule"}]}]},{"description":"HC REPAIR INT FACE 2.5CM/<","code_information":[{"code":"12051","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":297.62,"maximum":3796,"gross_charge":1267,"discounted_cash":596.87,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":798.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":798.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":798.21,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":3796,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3212,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":785.06,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":798.21,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":798.21,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1152.97,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":608.16,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":950.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":342.09,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":359.2,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":335.25,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":297.62,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":348.94,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":352.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":404.31,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":392.53,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":392.53,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":412.16,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":408.23,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":392.53,"methodology":"case rate"}]}]},{"description":"HC REPAIR INT FACE 2.6-5CM","code_information":[{"code":"12052","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":678.86,"maximum":678.86,"gross_charge":746,"discounted_cash":351.43,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":678.86,"methodology":"fee schedule"}]}]},{"description":"HC REPAIR INT FACE 2.6-5CM","code_information":[{"code":"12052","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":175.24,"maximum":1538.38,"gross_charge":746,"discounted_cash":351.43,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":469.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":469.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":469.98,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":395.38,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":350.62,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":785.06,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":469.98,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":469.98,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":678.86,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":358.08,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":559.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":201.42,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":211.5,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":197.4,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":175.24,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":205.45,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":207.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":404.31,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":392.53,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":392.53,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":412.16,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":408.23,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":392.53,"methodology":"case rate"}]}]},{"description":"HC REPAIR INT FACE 5.1-7.5CM","code_information":[{"code":"12053","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":692.51,"maximum":692.51,"gross_charge":761,"discounted_cash":358.5,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":692.51,"methodology":"fee schedule"}]}]},{"description":"HC REPAIR INT FACE 5.1-7.5CM","code_information":[{"code":"12053","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":178.76,"maximum":1538.38,"gross_charge":761,"discounted_cash":358.5,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":479.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":479.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":479.43,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":403.33,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":357.67,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":785.06,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":479.43,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":479.43,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":692.51,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":365.28,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":570.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":205.47,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":215.75,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":201.37,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":178.76,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":209.58,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":211.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":404.31,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":392.53,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":392.53,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":412.16,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":408.23,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":392.53,"methodology":"case rate"}]}]},{"description":"HC REPAIR INT FACE 7.6-12.5 CM","code_information":[{"code":"12054","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":712.53,"maximum":712.53,"gross_charge":783,"discounted_cash":368.86,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":712.53,"methodology":"fee schedule"}]}]},{"description":"HC REPAIR INT FACE 7.6-12.5 CM","code_information":[{"code":"12054","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":183.93,"maximum":2376,"gross_charge":783,"discounted_cash":368.86,"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 - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2376,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":2011,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":785.06,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":493.29,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":493.29,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1923.63,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":712.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":375.84,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":587.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":211.41,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":221.99,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":207.19,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":183.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":215.64,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":217.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":404.31,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":392.53,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":392.53,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":412.16,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":408.23,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":392.53,"methodology":"case rate"}]}]},{"description":"HC REPAIR INT FACE 12.6-20CM","code_information":[{"code":"12055","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":712.53,"maximum":712.53,"gross_charge":783,"discounted_cash":368.86,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":712.53,"methodology":"fee schedule"}]}]},{"description":"HC REPAIR INT FACE 12.6-20CM","code_information":[{"code":"12055","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":183.93,"maximum":2376,"gross_charge":783,"discounted_cash":368.86,"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 - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2376,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":2011,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":785.06,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":493.29,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":493.29,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1923.63,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":712.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":375.84,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":587.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":211.41,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":221.99,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":207.19,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":183.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":215.64,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":217.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":404.31,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":392.53,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":392.53,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":412.16,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":408.23,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":392.53,"methodology":"case rate"}]}]},{"description":"HC LAYR CLOS WND FACEFACIAL 20.1-30 CM","code_information":[{"code":"12056","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":726.18,"maximum":726.18,"gross_charge":798,"discounted_cash":375.93,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":726.18,"methodology":"fee schedule"}]}]},{"description":"HC LAYR CLOS WND FACEFACIAL 20.1-30 CM","code_information":[{"code":"12056","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":187.46,"maximum":2376,"gross_charge":798,"discounted_cash":375.93,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":502.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":502.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":502.74,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2376,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":2011,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":785.06,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":502.74,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":502.74,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1923.63,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":726.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":383.04,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":598.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":215.46,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":226.24,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":211.16,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":187.46,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":219.77,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":221.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":404.31,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":392.53,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":392.53,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":412.16,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":408.23,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":392.53,"methodology":"case rate"}]}]},{"description":"HC LAYR CLOS WND FACEFACIAL >30 CM","code_information":[{"code":"12057","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":746.2,"maximum":746.2,"gross_charge":820,"discounted_cash":386.29,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":746.2,"methodology":"fee schedule"}]}]},{"description":"HC LAYR CLOS WND FACEFACIAL >30 CM","code_information":[{"code":"12057","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":192.62,"maximum":2376,"gross_charge":820,"discounted_cash":386.29,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":516.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":516.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":516.6,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2376,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":2011,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":785.06,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":516.6,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":516.6,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1923.63,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":746.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":393.6,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":615,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":221.4,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":232.47,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":216.98,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":192.62,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":225.83,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":228.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":404.31,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":392.53,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":392.53,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":412.16,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":408.23,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":392.53,"methodology":"case rate"}]}]},{"description":"ACUTE MAJOR EYE INFECTIONS WITH CC/MCC","code_information":[{"code":"121","type":"MS-DRG"}],"standard_charges":[{"minimum":7289.37,"maximum":17514,"setting":"inpatient","payers_information":[{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":17514,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":15661,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":17051.14,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":14557,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17213,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":15878,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":7289.37,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":8504.27,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":8099.3,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":8261.29,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":8261.29,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":8261.29,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":8781.34,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":8568.2,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":8525.57,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":8951.85,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":8738.71,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":8525.57,"methodology":"case rate"}]}]},{"description":"ACUTE MAJOR EYE INFECTIONS WITHOUT CC/MCC","code_information":[{"code":"122","type":"MS-DRG"}],"standard_charges":[{"minimum":4372.82,"maximum":10228.8,"setting":"inpatient","payers_information":[{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":10213,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":9133,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":10228.8,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":8489,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10037,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":9259,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":4372.82,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":5101.62,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":4858.68,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":4955.86,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":4955.86,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4955.86,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5267.84,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":5139.98,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5114.4,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":5370.12,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":5242.26,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":5114.4,"methodology":"case rate"}]}]},{"description":"NEUROLOGICAL EYE DISORDERS","code_information":[{"code":"123","type":"MS-DRG"}],"standard_charges":[{"minimum":5124.06,"maximum":12094,"setting":"inpatient","payers_information":[{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":12094,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":10814,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":11986.08,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":10052,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11886,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":10964,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":5124.06,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":5978.06,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":5693.39,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":5807.26,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":5807.26,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5807.26,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6172.84,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":6023.01,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5993.04,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":6292.7,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6142.87,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":5993.04,"methodology":"case rate"}]}]},{"description":"OTHER DISORDERS OF THE EYE WITH MCC OR THROMBOLYTIC AGENT","code_information":[{"code":"124","type":"MS-DRG"}],"standard_charges":[{"minimum":8135.64,"maximum":19633,"setting":"inpatient","payers_information":[{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":19633,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":17556,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":19030.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":16318,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":19295,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":17798,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":8135.64,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":9491.58,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":9039.6,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":9220.4,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":9220.4,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":9220.4,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":9800.83,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":9562.94,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":9515.36,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":9991.13,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":9753.25,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":9515.36,"methodology":"case rate"}]}]},{"description":"OTHER DISORDERS OF THE EYE WITHOUT MCC","code_information":[{"code":"125","type":"MS-DRG"}],"standard_charges":[{"minimum":5259.4,"maximum":12433,"setting":"inpatient","payers_information":[{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":12433,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":11117,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":12302.66,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":10333,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12219,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":11271,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":5259.4,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":6135.96,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":5843.77,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":5960.65,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":5960.65,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5960.65,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6335.87,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":6182.09,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6151.33,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":6458.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.12,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":6151.33,"methodology":"case rate"}]}]},{"description":"HC ROOM CHARGE SEMI PRIVATE ONCOLOGY","code_information":[{"code":"1270000000","type":"CDM"},{"code":"0127","type":"RC"}],"standard_charges":[{"minimum":2019.29,"maximum":2019.29,"gross_charge":2219,"discounted_cash":1045.34,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4840,"methodology":"per diem"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4840,"methodology":"per diem"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4840,"methodology":"per diem"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1932,"methodology":"per diem"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":1932,"methodology":"per diem"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2019.29,"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":879.06,"maximum":879.06,"gross_charge":966,"discounted_cash":455.07,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":879.06,"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":226.92,"maximum":2376,"gross_charge":966,"discounted_cash":455.07,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":608.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":608.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":608.58,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2376,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":2011,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":1202.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":608.58,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":608.58,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1923.63,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":879.06,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":463.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":724.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":260.82,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":273.87,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":255.61,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":226.92,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":266.04,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":268.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":619.45,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":601.41,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":601.41,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":631.48,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":625.47,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":601.41,"methodology":"case rate"}]}]},{"description":"HC REPAIR COMP TRNK 2.6-7.5CM","code_information":[{"code":"13101","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":976.43,"maximum":976.43,"gross_charge":1073,"discounted_cash":505.48,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":976.43,"methodology":"fee schedule"}]}]},{"description":"HC REPAIR COMP TRNK 2.6-7.5CM","code_information":[{"code":"13101","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":252.05,"maximum":3796,"gross_charge":1073,"discounted_cash":505.48,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":675.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":675.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":675.99,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":3796,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3212,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":1202.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":675.99,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":675.99,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2657.78,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":976.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":515.04,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":804.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":289.71,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":304.2,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":283.92,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":252.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":295.51,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":298.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":619.45,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":601.41,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":601.41,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":631.48,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":625.47,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":601.41,"methodology":"case rate"}]}]},{"description":"HC REPAIR COMP TRNK ADDL 5 CM/<","code_information":[{"code":"13102","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":830.83,"maximum":830.83,"gross_charge":913,"discounted_cash":430.1,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":830.83,"methodology":"fee schedule"}]}]},{"description":"HC REPAIR COMP TRNK ADDL 5 CM/<","code_information":[{"code":"13102","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":214.47,"maximum":1538.38,"gross_charge":913,"discounted_cash":430.1,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":575.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":575.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":575.19,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":483.89,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":429.11,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":575.19,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":575.19,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":830.83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":438.24,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":684.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":246.51,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":258.84,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":241.58,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":214.47,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":251.45,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":253.91,"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":915.46,"maximum":915.46,"gross_charge":1006,"discounted_cash":473.91,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":915.46,"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":236.31,"maximum":2376,"gross_charge":1006,"discounted_cash":473.91,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":633.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":633.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":633.78,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2376,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":2011,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":1202.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":633.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":633.78,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1923.63,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":915.46,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":482.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":754.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":271.62,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":285.21,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":266.19,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":236.31,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":277.06,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":279.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":619.45,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":601.41,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":601.41,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":631.48,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":625.47,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":601.41,"methodology":"case rate"}]}]},{"description":"HC REPAIR COMP S/A/L 2.6-7.5CM","code_information":[{"code":"13121","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":942.76,"maximum":942.76,"gross_charge":1036,"discounted_cash":488.05,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":942.76,"methodology":"fee schedule"}]}]},{"description":"HC REPAIR COMP S/A/L 2.6-7.5CM","code_information":[{"code":"13121","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":243.36,"maximum":3796,"gross_charge":1036,"discounted_cash":488.05,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":652.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":652.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":652.68,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":3796,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3212,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":1202.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":652.68,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":652.68,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2657.78,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":942.76,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":497.28,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":777,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":279.72,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":293.71,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":274.13,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":243.36,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":285.32,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":288.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":619.45,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":601.41,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":601.41,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":631.48,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":625.47,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":601.41,"methodology":"case rate"}]}]},{"description":"HC REPAIR COMP S/A/L EA 5CM/<","code_information":[{"code":"13122","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":600.6,"maximum":600.6,"gross_charge":660,"discounted_cash":310.92,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":600.6,"methodology":"fee schedule"}]}]},{"description":"HC REPAIR COMP S/A/L EA 5CM/<","code_information":[{"code":"13122","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":155.04,"maximum":1538.38,"gross_charge":660,"discounted_cash":310.92,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":415.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":415.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":415.8,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":349.8,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":310.2,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":415.8,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":415.8,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":600.6,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":316.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":495,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":178.2,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":187.11,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":174.64,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":155.04,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":181.77,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":183.55,"methodology":"fee schedule"}]}]},{"description":"HC REPAIR COMP FACE 1.1-2.5CM","code_information":[{"code":"13131","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":700.7,"maximum":700.7,"gross_charge":770,"discounted_cash":362.74,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":700.7,"methodology":"fee schedule"}]}]},{"description":"HC REPAIR COMP FACE 1.1-2.5CM","code_information":[{"code":"13131","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":180.88,"maximum":2376,"gross_charge":770,"discounted_cash":362.74,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":485.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":485.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":485.1,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2376,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":2011,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":785.06,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":485.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":485.1,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1923.63,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":700.7,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":369.6,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":577.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":207.9,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":218.3,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":203.75,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":180.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":212.06,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":214.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":404.31,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":392.53,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":392.53,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":412.16,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":408.23,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":392.53,"methodology":"case rate"}]}]},{"description":"HC REPAIR COMP FACE 2.6-7.5CM","code_information":[{"code":"13132","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":707.07,"maximum":707.07,"gross_charge":777,"discounted_cash":366.04,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":707.07,"methodology":"fee schedule"}]}]},{"description":"HC REPAIR COMP FACE 2.6-7.5CM","code_information":[{"code":"13132","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":182.52,"maximum":3796,"gross_charge":777,"discounted_cash":366.04,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":489.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":489.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":489.51,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":3796,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3212,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":1202.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":489.51,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":489.51,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2657.78,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":707.07,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":372.96,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":582.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":209.79,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":220.28,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":205.6,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":182.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":213.99,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":216.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":619.45,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":601.41,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":601.41,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":631.48,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":625.47,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":601.41,"methodology":"case rate"}]}]},{"description":"HC REPAIR COMP FACE EA 5CM/<","code_information":[{"code":"13133","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":600.6,"maximum":600.6,"gross_charge":660,"discounted_cash":310.92,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":600.6,"methodology":"fee schedule"}]}]},{"description":"HC REPAIR COMP FACE EA 5CM/<","code_information":[{"code":"13133","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":155.04,"maximum":1538.38,"gross_charge":660,"discounted_cash":310.92,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":415.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":415.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":415.8,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":349.8,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":310.2,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":415.8,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":415.8,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":600.6,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":316.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":495,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":178.2,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":187.11,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":174.64,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":155.04,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":181.77,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":183.55,"methodology":"fee schedule"}]}]},{"description":"HC REPAIRCOMP E/N/E/L 1.1-2.5","code_information":[{"code":"13151","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":762.58,"maximum":762.58,"gross_charge":838,"discounted_cash":394.77,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":762.58,"methodology":"fee schedule"}]}]},{"description":"HC REPAIRCOMP E/N/E/L 1.1-2.5","code_information":[{"code":"13151","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":196.85,"maximum":3796,"gross_charge":838,"discounted_cash":394.77,"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":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":3796,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3212,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":1202.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":527.94,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":527.94,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2657.78,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":762.58,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":402.24,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":628.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":226.26,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":237.58,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":221.74,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":196.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":230.79,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":233.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":619.45,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":601.41,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":601.41,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":631.48,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":625.47,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":601.41,"methodology":"case rate"}]}]},{"description":"HC REPAIR COMP E/N/E/L 2.6-7.5","code_information":[{"code":"13152","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":778.96,"maximum":778.96,"gross_charge":856,"discounted_cash":403.25,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":778.96,"methodology":"fee schedule"}]}]},{"description":"HC REPAIR COMP E/N/E/L 2.6-7.5","code_information":[{"code":"13152","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":201.08,"maximum":3796,"gross_charge":856,"discounted_cash":403.25,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":539.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":539.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":539.28,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":3796,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3212,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":1202.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":539.28,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":539.28,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2657.78,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":778.96,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":410.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":642,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":231.12,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":242.68,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":226.5,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":201.08,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":235.75,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":238.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":619.45,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":601.41,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":601.41,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":631.48,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":625.47,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":601.41,"methodology":"case rate"}]}]},{"description":"HC REPREYELIDNOSEEARLIP+5 CM","code_information":[{"code":"13153","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":739.83,"maximum":739.83,"gross_charge":813,"discounted_cash":383,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":739.83,"methodology":"fee schedule"}]}]},{"description":"HC REPREYELIDNOSEEARLIP+5 CM","code_information":[{"code":"13153","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":190.98,"maximum":2657.78,"gross_charge":813,"discounted_cash":383,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":512.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":512.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":512.19,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":430.89,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":382.11,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":512.19,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":512.19,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2657.78,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":739.83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":390.24,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":609.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":219.51,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":230.49,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":215.12,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":190.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":223.91,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":226.1,"methodology":"fee schedule"}]}]},{"description":"HC SECONDARY CLOSURE/SURG WOUND","code_information":[{"code":"13160","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":1067.43,"maximum":1067.43,"gross_charge":1173,"discounted_cash":552.59,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1067.43,"methodology":"fee schedule"}]}]},{"description":"HC SECONDARY CLOSURE/SURG WOUND","code_information":[{"code":"13160","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":275.54,"maximum":3594.36,"gross_charge":1173,"discounted_cash":552.59,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":738.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":738.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":738.99,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2376,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":2011,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":3594.36,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":738.99,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":738.99,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1923.63,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1067.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":563.04,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":879.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":316.71,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":332.55,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":310.38,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":275.54,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":323.05,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":326.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1851.1,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":1797.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1797.18,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":1887.04,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1869.07,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":1797.18,"methodology":"case rate"}]}]},{"description":"SINUS AND MASTOID PROCEDURES WITH CC/MCC","code_information":[{"code":"135","type":"MS-DRG"}],"standard_charges":[{"minimum":14795.17,"maximum":36304,"setting":"inpatient","payers_information":[{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":36304,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":32463,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":34608.56,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":30174,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":35679,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":32912,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":14795.17,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":17261.03,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":16439.07,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":16767.86,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":16767.86,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":16767.86,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":17823.41,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":17390.81,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":17304.28,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":18169.5,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":17736.89,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":17304.28,"methodology":"case rate"}]}]},{"description":"SINUS AND MASTOID PROCEDURES WITHOUT CC/MCC","code_information":[{"code":"136","type":"MS-DRG"}],"standard_charges":[{"minimum":6176.64,"maximum":14729,"setting":"inpatient","payers_information":[{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":14729,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":13170,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":14448.26,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":12242,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14475,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":13352,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":6176.64,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":7206.08,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":6862.93,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":7000.19,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":7000.19,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":7000.19,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":7440.86,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":7260.26,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7224.13,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":7585.34,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7404.74,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":7224.13,"methodology":"case rate"}]}]},{"description":"MOUTH PROCEDURES WITH CC/MCC","code_information":[{"code":"137","type":"MS-DRG"}],"standard_charges":[{"minimum":8705.25,"maximum":21059,"setting":"inpatient","payers_information":[{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":21059,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":18831,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":20363.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":17503,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":20696,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":19091,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":8705.25,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":10156.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":9672.49,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":9865.94,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":9865.94,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":9865.94,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":10487.01,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":10232.47,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":10181.56,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":10690.64,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":10436.1,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":10181.56,"methodology":"case rate"}]}]},{"description":"MOUTH PROCEDURES WITHOUT CC/MCC","code_information":[{"code":"138","type":"MS-DRG"}],"standard_charges":[{"minimum":5186.01,"maximum":12249,"setting":"inpatient","payers_information":[{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":12249,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":10953,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":12131,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":10181,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12038,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":11104,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":5186.01,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":6050.35,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":5762.23,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":5877.48,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":5877.48,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5877.48,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6247.47,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":6095.83,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6065.5,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":6368.78,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6217.14,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":6065.5,"methodology":"case rate"}]}]},{"description":"SALIVARY GLAND PROCEDURES","code_information":[{"code":"139","type":"MS-DRG"}],"standard_charges":[{"minimum":8551.26,"maximum":20673,"setting":"inpatient","payers_information":[{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":20673,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":18486,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":20002.94,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":17182,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":20318,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":18741,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":8551.26,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":9976.47,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":9501.4,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":9691.43,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":9691.43,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":9691.43,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":10301.52,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":10051.48,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":10001.47,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":10501.55,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":10251.51,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":10001.47,"methodology":"case rate"}]}]},{"description":"MAJOR HEAD AND NECK PROCEDURES WITH MCC","code_information":[{"code":"140","type":"MS-DRG"}],"standard_charges":[{"minimum":25730.58,"maximum":63679,"setting":"inpatient","payers_information":[{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":63679,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":56942,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":60188.48,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":52927,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":62584,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":57729,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":25730.58,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":30019.01,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":28589.53,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":29161.33,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":29161.33,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":29161.33,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":30997.07,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":30244.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":30094.24,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":31598.96,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":30846.6,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":30094.24,"methodology":"case rate"}]}]},{"description":"TIS TRNFR TRUNK 10 SQ CM/<","code_information":[{"code":"14000","type":"CPT"}],"standard_charges":[{"minimum":1797.18,"maximum":3594.36,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2376,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":2011,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":3594.36,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1923.63,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1851.1,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":1797.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1797.18,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":1887.04,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1869.07,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":1797.18,"methodology":"case rate"}]}]},{"description":"TIS TRNFR TRUNK 10.1-30SQCM","code_information":[{"code":"14001","type":"CPT"}],"standard_charges":[{"minimum":1797.18,"maximum":3796,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":3796,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3212,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":3594.36,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":2657.78,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1851.1,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":1797.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1797.18,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":1887.04,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1869.07,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":1797.18,"methodology":"case rate"}]}]},{"description":"TIS TRNFR S/A/L 10 SQ CM/<","code_information":[{"code":"14020","type":"CPT"}],"standard_charges":[{"minimum":1797.18,"maximum":3796,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":3796,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3212,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":3594.36,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":2657.78,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1851.1,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":1797.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1797.18,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":1887.04,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1869.07,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":1797.18,"methodology":"case rate"}]}]},{"description":"TIS TRNFR S/A/L 10.1-30 SQCM","code_information":[{"code":"14021","type":"CPT"}],"standard_charges":[{"minimum":1797.18,"maximum":3796,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":3796,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3212,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":3594.36,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":2657.78,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1851.1,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":1797.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1797.18,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":1887.04,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1869.07,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":1797.18,"methodology":"case rate"}]}]},{"description":"HC ADJ TISS XFER HEADFACHAND <10 SQCM","code_information":[{"code":"14040","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":2356.9,"maximum":2356.9,"gross_charge":2590,"discounted_cash":1220.11,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2356.9,"methodology":"fee schedule"}]}]},{"description":"HC ADJ TISS XFER HEADFACHAND <10 SQCM","code_information":[{"code":"14040","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":608.4,"maximum":3594.36,"gross_charge":2590,"discounted_cash":1220.11,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1631.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1631.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1631.7,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2376,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":2011,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":3594.36,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1631.7,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":1631.7,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1923.63,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2356.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1243.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":1942.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":699.3,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":734.27,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":685.32,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":608.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":713.29,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":720.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1851.1,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":1797.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1797.18,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":1887.04,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1869.07,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":1797.18,"methodology":"case rate"}]}]},{"description":"TIS TRNFR F/C/C/M/N/A/G/H/F","code_information":[{"code":"14041","type":"CPT"}],"standard_charges":[{"minimum":1797.18,"maximum":3796,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":3796,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3212,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":3594.36,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":2657.78,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1851.1,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":1797.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1797.18,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":1887.04,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1869.07,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":1797.18,"methodology":"case rate"}]}]},{"description":"TIS TRNFR E/N/E/L 10 SQ CM/<","code_information":[{"code":"14060","type":"CPT"}],"standard_charges":[{"minimum":1797.18,"maximum":3796,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":3796,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3212,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":3594.36,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":2657.78,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1851.1,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":1797.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1797.18,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":1887.04,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1869.07,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":1797.18,"methodology":"case rate"}]}]},{"description":"TIS TRNFR E/N/E/L10.1-30SQCM","code_information":[{"code":"14061","type":"CPT"}],"standard_charges":[{"minimum":1797.18,"maximum":3796,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":3796,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3212,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":3594.36,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":2657.78,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1851.1,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":1797.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1797.18,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":1887.04,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1869.07,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":1797.18,"methodology":"case rate"}]}]},{"description":"MAJOR HEAD AND NECK PROCEDURES WITH CC","code_information":[{"code":"141","type":"MS-DRG"}],"standard_charges":[{"minimum":13215.7,"maximum":32350,"setting":"inpatient","payers_information":[{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":32350,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":28927,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":30913.9,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":26888,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":31794,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":29327,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":13215.7,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":15418.32,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":14684.11,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":14977.8,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":14977.8,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":14977.8,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":15920.66,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":15534.24,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":15456.95,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":16229.8,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":15843.38,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":15456.95,"methodology":"case rate"}]}]},{"description":"MAJOR HEAD AND NECK PROCEDURES WITHOUT CC/MCC","code_information":[{"code":"142","type":"MS-DRG"}],"standard_charges":[{"minimum":9750.6,"maximum":23676,"setting":"inpatient","payers_information":[{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":23676,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":21171,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":22808.42,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":19678,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":23268,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":21463,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":9750.6,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":11375.7,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":10834,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":11050.68,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":11050.68,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11050.68,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":11746.34,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":11461.24,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":11404.21,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":11974.43,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":11689.32,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":11404.21,"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":20153.11,"maximum":49717,"setting":"inpatient","payers_information":[{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":49717,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":44457,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":47141.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":41322,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":48862,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":45071,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":20153.11,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":23511.96,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":22392.34,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":22840.19,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":22840.19,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":22840.19,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":24278.01,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":23688.74,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":23570.88,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":24749.43,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":24160.16,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":23570.88,"methodology":"case rate"}]}]},{"description":"TIS TRNFR ANY 30.1-60 SQ CM","code_information":[{"code":"14301","type":"CPT"}],"standard_charges":[{"minimum":2657.78,"maximum":7193.66,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":4157,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3517,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":7193.66,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"median_amount":694.25,"10th_percentile":694.18,"90th_percentile":694.25,"count":"1 through 10","methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"median_amount":694.25,"10th_percentile":694.18,"90th_percentile":694.25,"count":"1 through 10","methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2657.78,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3704.73,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":3596.83,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3596.83,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":3776.67,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3740.7,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":3596.83,"methodology":"case rate"}]}]},{"description":"TIS TRNFR ADDL 30 SQ CM","code_information":[{"code":"14302","type":"CPT"}],"standard_charges":[{"minimum":3517,"maximum":4157,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":4157,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3517,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"median_amount":694.18,"10th_percentile":694.18,"90th_percentile":694.18,"count":"12","methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"median_amount":694.18,"10th_percentile":694.18,"90th_percentile":694.18,"count":"12","methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_percentage":52,"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":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"FILLETED FINGER/TOE FLAP","code_information":[{"code":"14350","type":"CPT"}],"standard_charges":[{"minimum":1797.18,"maximum":3796,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":3796,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3212,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":3594.36,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":2657.78,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1851.1,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":1797.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1797.18,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":1887.04,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1869.07,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":1797.18,"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":10859.13,"maximum":26451,"setting":"inpatient","payers_information":[{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":26451,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":23652,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":25401.44,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":21984,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":25996,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":23979,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":10859.13,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":12668.98,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":12065.69,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":12307.01,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":12307.01,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12307.01,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":13081.75,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":12764.23,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":12700.72,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":13335.76,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":13018.24,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":12700.72,"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":7419.29,"maximum":17840,"setting":"inpatient","payers_information":[{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":17840,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":15952,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":17355.04,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":14827,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17533,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":16173,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":7419.29,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":8655.84,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":8243.65,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":8408.53,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":8408.53,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":8408.53,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":8937.85,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":8720.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":8677.52,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":9111.4,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":8894.46,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":8677.52,"methodology":"case rate"}]}]},{"description":"EAR NOSE MOUTH AND THROAT MALIGNANCY WITH MCC","code_information":[{"code":"146","type":"MS-DRG"}],"standard_charges":[{"minimum":14091.44,"maximum":34542,"setting":"inpatient","payers_information":[{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":34542,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":30888,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":32962.42,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":28710,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":33948,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":31314,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":14091.44,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":16440.01,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":15657.15,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":15970.3,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":15970.3,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":15970.3,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":16975.65,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":16563.62,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":16481.21,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":17305.28,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":16893.25,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":16481.21,"methodology":"case rate"}]}]},{"description":"EAR NOSE MOUTH AND THROAT MALIGNANCY WITH CC","code_information":[{"code":"147","type":"MS-DRG"}],"standard_charges":[{"minimum":7780.17,"maximum":18743,"setting":"inpatient","payers_information":[{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":18743,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":16760,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":18199.22,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":15578,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":18421,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":16992,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":7780.17,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":9076.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":8644.63,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":8817.53,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":8817.53,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":8817.53,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":9372.6,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":9145.11,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":9099.61,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":9554.6,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":9327.11,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":9099.61,"methodology":"case rate"}]}]},{"description":"EAR NOSE MOUTH AND THROAT MALIGNANCY WITHOUT CC/MCC","code_information":[{"code":"148","type":"MS-DRG"}],"standard_charges":[{"minimum":5109.03,"maximum":12056,"setting":"inpatient","payers_information":[{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":12056,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":10781,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":11950.92,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":10020,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11849,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":10930,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":5109.03,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":5960.53,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":5676.69,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":5790.23,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":5790.23,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5790.23,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6154.73,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":6005.34,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5975.46,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":6274.24,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6124.85,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":5975.46,"methodology":"case rate"}]}]},{"description":"DYSEQUILIBRIUM","code_information":[{"code":"149","type":"MS-DRG"}],"standard_charges":[{"minimum":4789.04,"maximum":11255,"setting":"inpatient","payers_information":[{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":11255,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":10064,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":11202.42,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":9355,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11062,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":10203,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":4789.04,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":5587.21,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":5321.15,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":5427.58,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":5427.58,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5427.58,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5769.25,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":5629.22,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5601.21,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":5881.28,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":5741.25,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":5601.21,"methodology":"case rate"}]}]},{"description":"EPISTAXIS WITH MCC","code_information":[{"code":"150","type":"MS-DRG"}],"standard_charges":[{"minimum":8606.61,"maximum":20812,"setting":"inpatient","payers_information":[{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":20812,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":18610,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":20132.38,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":17298,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":20454,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":18867,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":8606.61,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":10041.04,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":9562.89,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":9754.15,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":9754.15,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":9754.15,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":10368.18,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":10116.53,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":10066.19,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":10569.5,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":10317.85,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":10066.19,"methodology":"case rate"}]}]},{"description":"HC SURG PREP LEGS ARMS TRUNK","code_information":[{"code":"15002","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":4161.43,"maximum":4161.43,"gross_charge":4573,"discounted_cash":2154.27,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4161.43,"methodology":"fee schedule"}]}]},{"description":"HC SURG PREP LEGS ARMS TRUNK","code_information":[{"code":"15002","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":1074.2,"maximum":4161.43,"gross_charge":4573,"discounted_cash":2154.27,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2880.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2880.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2880.99,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2152,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":1821,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":3594.36,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2880.99,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2880.99,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1923.63,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4161.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2195.04,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":3429.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":1234.71,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":1296.45,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":1210.02,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":1074.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1259.41,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1271.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1851.1,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":1797.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1797.18,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":1887.04,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1869.07,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":1797.18,"methodology":"case rate"}]}]},{"description":"WOUND PREP ADDL 100 CM","code_information":[{"code":"15003","type":"CPT"}],"standard_charges":[{"minimum":1538.38,"maximum":1538.38,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"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|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"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":1368.64,"maximum":1368.64,"gross_charge":1504,"discounted_cash":708.51,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1368.64,"methodology":"fee schedule"}]}]},{"description":"HC SURG PREP FEET HANDS","code_information":[{"code":"15004","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":353.29,"maximum":2152,"gross_charge":1504,"discounted_cash":708.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":947.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":947.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":947.52,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2152,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":1821,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":1202.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":947.52,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":947.52,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1923.63,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1368.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":721.92,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":1128,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":406.08,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":426.39,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":397.96,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":353.29,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":414.21,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":418.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":619.45,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":601.41,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":601.41,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":631.48,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":625.47,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":601.41,"methodology":"case rate"}]}]},{"description":"WND PREP F/N/HF/G ADDL CM","code_information":[{"code":"15005","type":"CPT"}],"standard_charges":[{"minimum":1538.38,"maximum":1538.38,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"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|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"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":1538.38,"maximum":3594.36,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2376,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":2011,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":3594.36,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1851.1,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":1797.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1797.18,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":1887.04,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1869.07,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":1797.18,"methodology":"case rate"}]}]},{"description":"HC SKIN PINCH GRAFT PROCEDURE <2 CM","code_information":[{"code":"15050","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":1019.2,"maximum":1019.2,"gross_charge":1120,"discounted_cash":527.62,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1019.2,"methodology":"fee schedule"}]}]},{"description":"HC SKIN PINCH GRAFT PROCEDURE <2 CM","code_information":[{"code":"15050","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":263.09,"maximum":2376,"gross_charge":1120,"discounted_cash":527.62,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":705.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":705.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":705.6,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2376,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":2011,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":1202.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":705.6,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":705.6,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1923.63,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1019.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":537.6,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":840,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":302.4,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":317.52,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":296.36,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":263.09,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":308.45,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":311.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":619.45,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":601.41,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":601.41,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":631.48,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":625.47,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":601.41,"methodology":"case rate"}]}]},{"description":"EPISTAXIS WITHOUT MCC","code_information":[{"code":"151","type":"MS-DRG"}],"standard_charges":[{"minimum":4852.19,"maximum":11413,"setting":"inpatient","payers_information":[{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":11413,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":10206,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":11350.14,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":9486,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11217,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":10347,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":4852.19,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":5660.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":5391.32,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":5499.15,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":5499.15,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5499.15,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5845.33,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":5703.45,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5675.07,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":5958.83,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":5816.95,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":5675.07,"methodology":"case rate"}]}]},{"description":"SKIN SPLT GRFT TRNK/ARM/LEG","code_information":[{"code":"15100","type":"CPT"}],"standard_charges":[{"minimum":1797.18,"maximum":3594.36,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2376,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":2011,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":3594.36,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1923.63,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1851.1,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":1797.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1797.18,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":1887.04,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1869.07,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":1797.18,"methodology":"case rate"}]}]},{"description":"SKIN SPLT GRFT T/A/L ADD-ON","code_information":[{"code":"15101","type":"CPT"}],"standard_charges":[{"minimum":2657.78,"maximum":3796,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":3796,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3212,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":2657.78,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC EPIDRM AUTOGRFT TRNK/ARM/LEG <100 SQCM","code_information":[{"code":"15110","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":6181.63,"maximum":6181.63,"gross_charge":6793,"discounted_cash":3200.07,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6181.63,"methodology":"fee schedule"}]}]},{"description":"HC EPIDRM AUTOGRFT TRNK/ARM/LEG <100 SQCM","code_information":[{"code":"15110","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":1538.38,"maximum":6181.63,"gross_charge":6793,"discounted_cash":3200.07,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4279.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4279.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4279.59,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2376,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":2011,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":3594.36,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4279.59,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":4279.59,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6181.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3260.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":5094.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":1834.11,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":1925.82,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":1797.43,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":1595.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1870.8,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1889.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1851.1,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":1797.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1797.18,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":1887.04,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1869.07,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":1797.18,"methodology":"case rate"}]}]},{"description":"HC EPIDRM AUTOGRFT TRNK/ARM/LEG EACH 100 SQCM","code_information":[{"code":"15111","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":1191.19,"maximum":1191.19,"gross_charge":1309,"discounted_cash":616.65,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1191.19,"methodology":"fee schedule"}]}]},{"description":"HC EPIDRM AUTOGRFT TRNK/ARM/LEG EACH 100 SQCM","code_information":[{"code":"15111","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":307.49,"maximum":2152,"gross_charge":1309,"discounted_cash":616.65,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":824.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":824.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":824.67,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2152,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":1821,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":824.67,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":824.67,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1191.19,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":628.32,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":981.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":353.43,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":371.11,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":346.37,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":307.49,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":360.5,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":364.04,"methodology":"fee schedule"}]}]},{"description":"HC EPI AUTOGRFT FACE/NCK/HND/FT/GEN <100 SQCM","code_information":[{"code":"15115","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":5887.7,"maximum":5887.7,"gross_charge":6470,"discounted_cash":3047.91,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5887.7,"methodology":"fee schedule"}]}]},{"description":"HC EPI AUTOGRFT FACE/NCK/HND/FT/GEN <100 SQCM","code_information":[{"code":"15115","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":1519.81,"maximum":5887.7,"gross_charge":6470,"discounted_cash":3047.91,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4076.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4076.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4076.1,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2376,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":2011,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":3594.36,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4076.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":4076.1,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5887.7,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3105.6,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":4852.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":1746.9,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":1834.25,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":1711.97,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":1519.81,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1781.84,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1799.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1851.1,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":1797.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1797.18,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":1887.04,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1869.07,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":1797.18,"methodology":"case rate"}]}]},{"description":"HC EPI AUTOGRFT FACE/NCK/HND/FT/GEN EA 100 SQCM","code_information":[{"code":"15116","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":1191.19,"maximum":1191.19,"gross_charge":1309,"discounted_cash":616.65,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1191.19,"methodology":"fee schedule"}]}]},{"description":"HC EPI AUTOGRFT FACE/NCK/HND/FT/GEN EA 100 SQCM","code_information":[{"code":"15116","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":307.49,"maximum":2152,"gross_charge":1309,"discounted_cash":616.65,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":824.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":824.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":824.67,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2152,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":1821,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":824.67,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":824.67,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1191.19,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":628.32,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":981.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":353.43,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":371.11,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":346.37,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":307.49,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":360.5,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":364.04,"methodology":"fee schedule"}]}]},{"description":"SKN SPLT A-GRFT FAC/NCK/HF/G","code_information":[{"code":"15120","type":"CPT"}],"standard_charges":[{"minimum":1923.63,"maximum":7193.66,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2376,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":2011,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":7193.66,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1923.63,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3704.73,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":3596.83,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3596.83,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":3776.67,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3740.7,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":3596.83,"methodology":"case rate"}]}]},{"description":"SKN SPLT A-GRFT F/N/HF/G ADD","code_information":[{"code":"15121","type":"CPT"}],"standard_charges":[{"minimum":2657.78,"maximum":3796,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":3796,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3212,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":2657.78,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"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":1797.18,"maximum":3594.36,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2376,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":2011,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":3594.36,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":2657.78,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1851.1,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":1797.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1797.18,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":1887.04,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1869.07,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":1797.18,"methodology":"case rate"}]}]},{"description":"DERM AUTOGRAFT T/A/L ADD-ON","code_information":[{"code":"15131","type":"CPT"}],"standard_charges":[{"minimum":1538.38,"maximum":2152,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2152,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":1821,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"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":1538.38,"maximum":7193.66,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2376,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":2011,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":7193.66,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3704.73,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":3596.83,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3596.83,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":3776.67,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3740.7,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":3596.83,"methodology":"case rate"}]}]},{"description":"DERM AUTOGRAFT F/N/HF/G ADD","code_information":[{"code":"15136","type":"CPT"}],"standard_charges":[{"minimum":1538.38,"maximum":2152,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2152,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":1821,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"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":1538.38,"maximum":3594.36,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2376,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":2011,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":3594.36,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1851.1,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":1797.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1797.18,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":1887.04,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1869.07,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":1797.18,"methodology":"case rate"}]}]},{"description":"CULT SKIN GRFT T/A/L ADDL","code_information":[{"code":"15151","type":"CPT"}],"standard_charges":[{"minimum":1538.38,"maximum":2152,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2152,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":1821,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"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":1538.38,"maximum":2152,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2152,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":1821,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"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":2011,"maximum":7193.66,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2376,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":2011,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":7193.66,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":2657.78,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3704.73,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":3596.83,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3596.83,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":3776.67,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3740.7,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":3596.83,"methodology":"case rate"}]}]},{"description":"CULT SKIN GRFT F/N/HFG ADD","code_information":[{"code":"15156","type":"CPT"}],"standard_charges":[{"minimum":1538.38,"maximum":2152,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2152,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":1821,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"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":1538.38,"maximum":2152,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2152,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":1821,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"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":7118.55,"maximum":17087,"setting":"inpatient","payers_information":[{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":17087,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":15279,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":16651.56,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":14202,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16793,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":15490,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":7118.55,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":8304.98,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":7909.5,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":8067.69,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":8067.69,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":8067.69,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":8575.56,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":8367.41,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":8325.78,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":8742.07,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":8533.93,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":8325.78,"methodology":"case rate"}]}]},{"description":"HC FTH/GFT FREE W/DIRECT CLOSURE TRUNK 20 CM/<","code_information":[{"code":"15200","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":4138.68,"maximum":4138.68,"gross_charge":4548,"discounted_cash":2142.49,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4138.68,"methodology":"fee schedule"}]}]},{"description":"HC FTH/GFT FREE W/DIRECT CLOSURE TRUNK 20 CM/<","code_information":[{"code":"15200","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":1068.33,"maximum":4138.68,"gross_charge":4548,"discounted_cash":2142.49,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2865.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2865.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2865.24,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":3796,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3212,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":3594.36,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2865.24,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2865.24,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2657.78,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4138.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2183.04,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":3411,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":1227.96,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":1289.36,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":1203.41,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":1068.33,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1252.52,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1264.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1851.1,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":1797.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1797.18,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":1887.04,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1869.07,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":1797.18,"methodology":"case rate"}]}]},{"description":"SKIN FULL GRAFT TRUNK ADD-ON","code_information":[{"code":"15201","type":"CPT"}],"standard_charges":[{"minimum":1923.63,"maximum":2376,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2376,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":2011,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1923.63,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"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":1797.18,"maximum":3594.36,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2376,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":2011,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":3594.36,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1923.63,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1851.1,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":1797.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1797.18,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":1887.04,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1869.07,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":1797.18,"methodology":"case rate"}]}]},{"description":"SKIN FULL GRAFT ADD-ON","code_information":[{"code":"15221","type":"CPT"}],"standard_charges":[{"minimum":1923.63,"maximum":2376,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2376,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":2011,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1923.63,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC FULL THICK GRFT HEADFACHAND <20SQC","code_information":[{"code":"15240","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":4058.6,"maximum":4058.6,"gross_charge":4460,"discounted_cash":2101.04,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4058.6,"methodology":"fee schedule"}]}]},{"description":"HC FULL THICK GRFT HEADFACHAND <20SQC","code_information":[{"code":"15240","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":1047.66,"maximum":4058.6,"gross_charge":4460,"discounted_cash":2101.04,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2809.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2809.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2809.8,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":3796,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3212,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":3594.36,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2809.8,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2809.8,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2657.78,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4058.6,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2140.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":3345,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":1204.2,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":1264.41,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":1180.12,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":1047.66,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1228.29,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1240.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1851.1,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":1797.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1797.18,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":1887.04,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1869.07,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":1797.18,"methodology":"case rate"}]}]},{"description":"SKIN FULL GRAFT ADD-ON","code_information":[{"code":"15241","type":"CPT"}],"standard_charges":[{"minimum":2657.78,"maximum":3796,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":3796,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3212,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":2657.78,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC FULL THICK GRFT NOSEARLID <20 SQCM","code_information":[{"code":"15260","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":780.78,"maximum":780.78,"gross_charge":858,"discounted_cash":404.19,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":780.78,"methodology":"fee schedule"}]}]},{"description":"HC FULL THICK GRFT NOSEARLID <20 SQCM","code_information":[{"code":"15260","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":201.55,"maximum":3594.36,"gross_charge":858,"discounted_cash":404.19,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":540.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":540.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":540.54,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2376,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":2011,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":3594.36,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":540.54,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":540.54,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1923.63,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":780.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":411.84,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":643.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":231.66,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":243.25,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":227.03,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":201.55,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":236.3,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":238.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1851.1,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":1797.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1797.18,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":1887.04,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1869.07,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":1797.18,"methodology":"case rate"}]}]},{"description":"SKIN FULL GRAFT ADD-ON","code_information":[{"code":"15261","type":"CPT"}],"standard_charges":[{"minimum":1923.63,"maximum":2376,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2376,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":2011,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1923.63,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC SKIN SUB GRFT LEG 1ST 25SQ HC","code_information":[{"code":"15271","type":"CPT"},{"code":"0761","type":"RC"}],"standard_charges":[{"minimum":3972.15,"maximum":3972.15,"gross_charge":4365,"discounted_cash":2056.28,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3972.15,"methodology":"fee schedule"}]}]},{"description":"HC SKIN SUB GRFT LEG 1ST 25SQ HC","code_information":[{"code":"15271","type":"CPT"},{"code":"0761","type":"RC"}],"standard_charges":[{"minimum":1025.34,"maximum":3972.15,"gross_charge":4365,"discounted_cash":2056.28,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2749.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2749.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2749.95,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2376,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":2011,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":3594.36,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2749.95,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2749.95,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3972.15,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2095.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":3273.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":1178.55,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":1237.48,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":1154.98,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":1025.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1202.13,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1213.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1851.1,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":1797.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1797.18,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":1887.04,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1869.07,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":1797.18,"methodology":"case rate"}]}]},{"description":"HC SKIN SUBST/A/L ADD 25SQCM HC","code_information":[{"code":"15272","type":"CPT"},{"code":"0761","type":"RC"}],"standard_charges":[{"minimum":635.18,"maximum":635.18,"gross_charge":698,"discounted_cash":328.82,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":635.18,"methodology":"fee schedule"}]}]},{"description":"HC SKIN SUBST/A/L ADD 25SQCM HC","code_information":[{"code":"15272","type":"CPT"},{"code":"0761","type":"RC"}],"standard_charges":[{"minimum":163.97,"maximum":2152,"gross_charge":698,"discounted_cash":328.82,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":439.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":439.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":439.74,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2152,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":1821,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":439.74,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":439.74,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":362.96,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":635.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":335.04,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":523.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":188.46,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":197.89,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":184.7,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":163.97,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":192.23,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":194.12,"methodology":"fee schedule"}]}]},{"description":"APP/SKIN SUBST/LEGS/>EQ 100SQ","code_information":[{"code":"15273","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":1906.45,"maximum":1906.45,"gross_charge":2095,"discounted_cash":986.92,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1906.45,"methodology":"fee schedule"}]}]},{"description":"APP/SKIN SUBST/LEGS/>EQ 100SQ","code_information":[{"code":"15273","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":492.12,"maximum":7193.66,"gross_charge":2095,"discounted_cash":986.92,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1319.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1319.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1319.85,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2376,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":2011,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":7193.66,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1319.85,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":1319.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2657.78,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1906.45,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1005.6,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":1571.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":565.65,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":593.94,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":554.34,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":492.12,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":576.97,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":582.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3704.73,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":3596.83,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3596.83,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":3776.67,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3740.7,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":3596.83,"methodology":"case rate"}]}]},{"description":"EA ADDL 100 SQ CM WOUND LEGS","code_information":[{"code":"15274","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":1271.27,"maximum":1271.27,"gross_charge":1397,"discounted_cash":658.11,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1271.27,"methodology":"fee schedule"}]}]},{"description":"EA ADDL 100 SQ CM WOUND LEGS","code_information":[{"code":"15274","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":328.16,"maximum":2152,"gross_charge":1397,"discounted_cash":658.11,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":880.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":880.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":880.11,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2152,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":1821,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":880.11,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":880.11,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":726.44,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1271.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":670.56,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":1047.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":377.19,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":396.05,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":369.65,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":328.16,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":384.74,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":388.51,"methodology":"fee schedule"}]}]},{"description":"HC APP.SKIN SUB FACE<100SQ CM","code_information":[{"code":"15275","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":1271.27,"maximum":1271.27,"gross_charge":1397,"discounted_cash":658.11,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1271.27,"methodology":"fee schedule"}]}]},{"description":"HC APP.SKIN SUB FACE<100SQ CM","code_information":[{"code":"15275","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":328.16,"maximum":3594.36,"gross_charge":1397,"discounted_cash":658.11,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":880.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":880.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":880.11,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2376,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":2011,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":3594.36,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":880.11,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":880.11,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1271.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":670.56,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":1047.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":377.19,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":396.05,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":369.65,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":328.16,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":384.74,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":388.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1851.1,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":1797.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1797.18,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":1887.04,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1869.07,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":1797.18,"methodology":"case rate"}]}]},{"description":"HC SKIN SUBSFEET/TOE 1ST 25SQ HC","code_information":[{"code":"15275","type":"CPT"},{"code":"0761","type":"RC"}],"standard_charges":[{"minimum":1310.4,"maximum":1310.4,"gross_charge":1440,"discounted_cash":678.36,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1310.4,"methodology":"fee schedule"}]}]},{"description":"HC SKIN SUBSFEET/TOE 1ST 25SQ HC","code_information":[{"code":"15275","type":"CPT"},{"code":"0761","type":"RC"}],"standard_charges":[{"minimum":338.26,"maximum":3594.36,"gross_charge":1440,"discounted_cash":678.36,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":907.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":907.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":907.2,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2376,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":2011,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":3594.36,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":907.2,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":907.2,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1310.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":691.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":1080,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":388.8,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":408.24,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":381.03,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":338.26,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":396.58,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":400.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1851.1,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":1797.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1797.18,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":1887.04,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1869.07,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":1797.18,"methodology":"case rate"}]}]},{"description":"HC SKIN SUBS FEE/TOE ADD 25SQC HC","code_information":[{"code":"15276","type":"CPT"},{"code":"0761","type":"RC"}],"standard_charges":[{"minimum":476.84,"maximum":476.84,"gross_charge":524,"discounted_cash":246.85,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":476.84,"methodology":"fee schedule"}]}]},{"description":"HC SKIN SUBS FEE/TOE ADD 25SQC HC","code_information":[{"code":"15276","type":"CPT"},{"code":"0761","type":"RC"}],"standard_charges":[{"minimum":123.09,"maximum":2152,"gross_charge":524,"discounted_cash":246.85,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":330.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":330.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":330.12,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2152,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":1821,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":330.12,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":330.12,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":272.48,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":476.84,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":251.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":393,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":141.48,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":148.56,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":138.66,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":123.09,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":144.31,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":145.73,"methodology":"fee schedule"}]}]},{"description":"APP/SKIN SUBS/FEET/>SQ 100SQCM","code_information":[{"code":"15277","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":1906.45,"maximum":1906.45,"gross_charge":2095,"discounted_cash":986.92,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1906.45,"methodology":"fee schedule"}]}]},{"description":"APP/SKIN SUBS/FEET/>SQ 100SQCM","code_information":[{"code":"15277","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":492.12,"maximum":3594.36,"gross_charge":2095,"discounted_cash":986.92,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1319.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1319.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1319.85,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2376,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":2011,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":3594.36,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1319.85,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":1319.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1906.45,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1005.6,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":1571.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":565.65,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":593.94,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":554.34,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":492.12,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":576.97,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":582.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1851.1,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":1797.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1797.18,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":1887.04,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1869.07,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":1797.18,"methodology":"case rate"}]}]},{"description":"EA ADDL 100 SQ CM WOUND FEET","code_information":[{"code":"15278","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":1271.27,"maximum":1271.27,"gross_charge":1397,"discounted_cash":658.11,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1271.27,"methodology":"fee schedule"}]}]},{"description":"EA ADDL 100 SQ CM WOUND FEET","code_information":[{"code":"15278","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":328.16,"maximum":2152,"gross_charge":1397,"discounted_cash":658.11,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":880.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":880.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":880.11,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2152,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":1821,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":880.11,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":880.11,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":726.44,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1271.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":670.56,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":1047.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":377.19,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":396.05,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":369.65,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":328.16,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":384.74,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":388.51,"methodology":"fee schedule"}]}]},{"description":"OTITIS MEDIA AND URI WITHOUT MCC","code_information":[{"code":"153","type":"MS-DRG"}],"standard_charges":[{"minimum":4573.71,"maximum":10716,"setting":"inpatient","payers_information":[{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":10716,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":9582,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":10698.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":8907,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10532,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":9715,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":4573.71,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":5336,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":5081.9,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":5183.54,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":5183.54,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5183.54,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5509.85,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":5376.11,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5349.36,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":5616.83,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":5483.1,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":5349.36,"methodology":"case rate"}]}]},{"description":"OTHER EAR NOSE MOUTH AND THROAT DIAGNOSES WITH MCC","code_information":[{"code":"154","type":"MS-DRG"}],"standard_charges":[{"minimum":10074.8,"maximum":24487,"setting":"inpatient","payers_information":[{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":24487,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":21897,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":23566.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":20352,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":24066,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":22199,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":10074.8,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":11753.94,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":11194.22,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":11418.11,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":11418.11,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11418.11,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":12136.89,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":11842.3,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":11783.38,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":12372.55,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":12077.97,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":11783.38,"methodology":"case rate"}]}]},{"description":"OTHER EAR NOSE MOUTH AND THROAT DIAGNOSES WITH CC","code_information":[{"code":"155","type":"MS-DRG"}],"standard_charges":[{"minimum":5908.39,"maximum":14057,"setting":"inpatient","payers_information":[{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":14057,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":12570,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":13820.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":11684,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13815,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":12744,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":5908.39,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":6893.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":6564.87,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":6696.17,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":6696.17,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6696.17,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":7117.7,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":6944.94,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6910.38,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":7255.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7083.14,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":6910.38,"methodology":"case rate"}]}]},{"description":"SKIN PEDICLE FLAP TRUNK","code_information":[{"code":"15570","type":"CPT"}],"standard_charges":[{"minimum":1797.18,"maximum":3796,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":3796,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3212,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":3594.36,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":2657.78,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1851.1,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":1797.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1797.18,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":1887.04,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1869.07,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":1797.18,"methodology":"case rate"}]}]},{"description":"SKIN PEDICLE FLAP ARMS/LEGS","code_information":[{"code":"15572","type":"CPT"}],"standard_charges":[{"minimum":2657.78,"maximum":7193.66,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":3796,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3212,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":7193.66,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":2657.78,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3704.73,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":3596.83,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3596.83,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":3776.67,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3740.7,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":3596.83,"methodology":"case rate"}]}]},{"description":"PEDCLE FH/CH/CH/M/N/AX/G/H/F","code_information":[{"code":"15574","type":"CPT"}],"standard_charges":[{"minimum":1797.18,"maximum":3796,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":3796,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3212,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":3594.36,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":2657.78,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1851.1,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":1797.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1797.18,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":1887.04,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1869.07,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":1797.18,"methodology":"case rate"}]}]},{"description":"PEDICLE E/N/E/L/NTRORAL","code_information":[{"code":"15576","type":"CPT"}],"standard_charges":[{"minimum":1797.18,"maximum":3796,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":3796,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3212,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":3594.36,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":2657.78,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1851.1,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":1797.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1797.18,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":1887.04,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1869.07,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":1797.18,"methodology":"case rate"}]}]},{"description":"OTHER EAR NOSE MOUTH AND THROAT DIAGNOSES WITHOUT CC/MCC","code_information":[{"code":"156","type":"MS-DRG"}],"standard_charges":[{"minimum":4337.33,"maximum":10145.78,"setting":"inpatient","payers_information":[{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":10124,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":9053,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":10145.78,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":8415,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9950,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":9178,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":4337.33,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":5060.22,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":4819.25,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":4915.64,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":4915.64,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4915.64,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5225.08,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":5098.26,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5072.89,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":5326.54,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":5199.72,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":5072.89,"methodology":"case rate"}]}]},{"description":"DELAY FLAP TRUNK","code_information":[{"code":"15600","type":"CPT"}],"standard_charges":[{"minimum":2657.78,"maximum":7193.66,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":3796,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3212,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":7193.66,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":2657.78,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3704.73,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":3596.83,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3596.83,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":3776.67,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3740.7,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":3596.83,"methodology":"case rate"}]}]},{"description":"DELAY FLAP ARMS/LEGS","code_information":[{"code":"15610","type":"CPT"}],"standard_charges":[{"minimum":1797.18,"maximum":3796,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":3796,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3212,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":3594.36,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":2657.78,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1851.1,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":1797.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1797.18,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":1887.04,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1869.07,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":1797.18,"methodology":"case rate"}]}]},{"description":"DELAY FLAP F/C/C/N/AX/G/H/F","code_information":[{"code":"15620","type":"CPT"}],"standard_charges":[{"minimum":1797.18,"maximum":4157,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":4157,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3517,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":3594.36,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":3078.06,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1851.1,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":1797.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1797.18,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":1887.04,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1869.07,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":1797.18,"methodology":"case rate"}]}]},{"description":"DELAY FLAP EYE/NOS/EAR/LIP","code_information":[{"code":"15630","type":"CPT"}],"standard_charges":[{"minimum":1797.18,"maximum":3796,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":3796,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3212,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":3594.36,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":2657.78,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1851.1,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":1797.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1797.18,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":1887.04,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1869.07,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":1797.18,"methodology":"case rate"}]}]},{"description":"TRANSFER SKIN PEDICLE FLAP","code_information":[{"code":"15650","type":"CPT"}],"standard_charges":[{"minimum":1797.18,"maximum":4514,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":4514,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3819,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":3594.36,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":3497.02,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1851.1,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":1797.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1797.18,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":1887.04,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1869.07,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":1797.18,"methodology":"case rate"}]}]},{"description":"DENTAL AND ORAL DISEASES WITH MCC","code_information":[{"code":"157","type":"MS-DRG"}],"standard_charges":[{"minimum":10142.17,"maximum":24656,"setting":"inpatient","payers_information":[{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":24656,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":22047,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":23724.34,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":20493,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":24232,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":22352,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":10142.17,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":11832.53,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":11269.07,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":11494.46,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":11494.46,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11494.46,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":12218.04,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":11921.49,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":11862.17,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":12455.28,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":12158.73,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":11862.17,"methodology":"case rate"}]}]},{"description":"MDFC FLAP W/PRSRV VASC PEDCL","code_information":[{"code":"15730","type":"CPT"}],"standard_charges":[{"minimum":3596.83,"maximum":7193.66,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":7193.66,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":3917.28,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3704.73,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":3596.83,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3596.83,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":3776.67,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3740.7,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":3596.83,"methodology":"case rate"}]}]},{"description":"FOREHEAD FLAP W/VASC PEDICLE","code_information":[{"code":"15731","type":"CPT"}],"standard_charges":[{"minimum":2657.78,"maximum":7193.66,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":3796,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3212,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":7193.66,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":2657.78,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3704.73,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":3596.83,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3596.83,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":3776.67,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3740.7,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":3596.83,"methodology":"case rate"}]}]},{"description":"MUSC MYOQ/FSCQ FLP HN PEDCL","code_information":[{"code":"15733","type":"CPT"}],"standard_charges":[{"minimum":3596.83,"maximum":7193.66,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":7193.66,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":3917.28,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3704.73,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":3596.83,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3596.83,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":3776.67,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3740.7,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":3596.83,"methodology":"case rate"}]}]},{"description":"MUSCLE-SKIN GRAFT TRUNK","code_information":[{"code":"15734","type":"CPT"}],"standard_charges":[{"minimum":2657.78,"maximum":7193.66,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":3796,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3212,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":7193.66,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":2657.78,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3704.73,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":3596.83,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3596.83,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":3776.67,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3740.7,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":3596.83,"methodology":"case rate"}]}]},{"description":"MUSCLE-SKIN GRAFT ARM","code_information":[{"code":"15736","type":"CPT"}],"standard_charges":[{"minimum":1797.18,"maximum":3796,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":3796,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3212,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":3594.36,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":2657.78,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1851.1,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":1797.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1797.18,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":1887.04,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1869.07,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":1797.18,"methodology":"case rate"}]}]},{"description":"MUSCLE-SKIN GRAFT LEG","code_information":[{"code":"15738","type":"CPT"}],"standard_charges":[{"minimum":2657.78,"maximum":7193.66,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":3796,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3212,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":7193.66,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":2657.78,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3704.73,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":3596.83,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3596.83,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":3776.67,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3740.7,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":3596.83,"methodology":"case rate"}]}]},{"description":"ISLAND PEDICLE FLAP GRAFT","code_information":[{"code":"15740","type":"CPT"}],"standard_charges":[{"minimum":1797.18,"maximum":3594.36,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2376,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":2011,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":3594.36,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1923.63,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1851.1,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":1797.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1797.18,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":1887.04,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1869.07,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":1797.18,"methodology":"case rate"}]}]},{"description":"NEUROVASCULAR PEDICLE FLAP","code_information":[{"code":"15750","type":"CPT"}],"standard_charges":[{"minimum":1923.63,"maximum":7193.66,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2376,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":2011,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":7193.66,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1923.63,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3704.73,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":3596.83,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3596.83,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":3776.67,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3740.7,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":3596.83,"methodology":"case rate"}]}]},{"description":"FREE MYO/SKIN FLAP MICROVASC","code_information":[{"code":"15756","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"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|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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":52,"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":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"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":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"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|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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":52,"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":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"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":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"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|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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":52,"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":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"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":1797.18,"maximum":3594.36,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2376,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":2011,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":3594.36,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1923.63,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1851.1,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":1797.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1797.18,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":1887.04,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1869.07,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":1797.18,"methodology":"case rate"}]}]},{"description":"GRFG AUTOL SOFT TISS DIR EXC","code_information":[{"code":"15769","type":"CPT"}],"standard_charges":[{"minimum":3212,"maximum":7193.66,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":3796,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3212,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":7193.66,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":3497.02,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3704.73,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":3596.83,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3596.83,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":3776.67,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3740.7,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":3596.83,"methodology":"case rate"}]}]},{"description":"HC DERMA-FAT-FASCIA GRAFT","code_information":[{"code":"15770","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":2485.21,"maximum":2485.21,"gross_charge":2731,"discounted_cash":1286.53,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2485.21,"methodology":"fee schedule"}]}]},{"description":"HC DERMA-FAT-FASCIA GRAFT","code_information":[{"code":"15770","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":641.52,"maximum":7193.66,"gross_charge":2731,"discounted_cash":1286.53,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1720.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1720.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1720.53,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":3796,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3212,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":7193.66,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1720.53,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":1720.53,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2657.78,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2485.21,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1310.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":2048.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":737.37,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":774.24,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":722.63,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":641.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":752.12,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":759.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3704.73,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":3596.83,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3596.83,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":3776.67,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3740.7,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":3596.83,"methodology":"case rate"}]}]},{"description":"GRFG AUTOL FAT LIPO 50 CC/<","code_information":[{"code":"15771","type":"CPT"}],"standard_charges":[{"minimum":3212,"maximum":7193.66,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"median_amount":1111.48,"10th_percentile":1111.48,"90th_percentile":1111.48,"count":"1 through 10","methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"median_amount":1111.48,"10th_percentile":1111.48,"90th_percentile":1111.48,"count":"1 through 10","methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"median_amount":1111.48,"10th_percentile":1111.48,"90th_percentile":1111.48,"count":"1 through 10","methodology":"percent of total billed charges"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":3796,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3212,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":7193.66,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":3497.02,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"median_amount":2368.35,"10th_percentile":2368.35,"90th_percentile":2368.35,"count":"1 through 10","methodology":"percent of total billed charges"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3704.73,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":3596.83,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3596.83,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":3776.67,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3740.7,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":3596.83,"methodology":"case rate"}]}]},{"description":"GRFG AUTOL FAT LIPO EA ADDL","code_information":[{"code":"15772","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"median_amount":1111.48,"10th_percentile":1111.48,"90th_percentile":1111.48,"count":"1 through 10","methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"median_amount":1111.48,"10th_percentile":1111.48,"90th_percentile":1111.48,"count":"1 through 10","methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"median_amount":1111.48,"10th_percentile":1111.48,"90th_percentile":1111.48,"count":"1 through 10","methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"median_amount":2368.33,"10th_percentile":672.15,"90th_percentile":2368.33,"count":"1 through 10","methodology":"percent of total billed charges"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"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":1538.38,"maximum":3594.36,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2376,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":2011,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":3594.36,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1851.1,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":1797.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1797.18,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":1887.04,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1869.07,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":1797.18,"methodology":"case rate"}]}]},{"description":"GFRG AUTOL FAT LIPO EA ADDL","code_information":[{"code":"15774","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"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|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"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":392.53,"maximum":3796,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":3796,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3212,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":785.06,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":2657.78,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":404.31,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":392.53,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":392.53,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":412.16,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":408.23,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":392.53,"methodology":"case rate"}]}]},{"description":"HAIR TRNSPL >15 PUNCH GRAFTS","code_information":[{"code":"15776","type":"CPT"}],"standard_charges":[{"minimum":392.53,"maximum":3796,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":3796,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3212,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":785.06,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":2657.78,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":404.31,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":392.53,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":392.53,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":412.16,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":408.23,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":392.53,"methodology":"case rate"}]}]},{"description":"ACELLULAR DERM MATRIX IMPLT","code_information":[{"code":"15777","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"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|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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":52,"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":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_percentage":48,"median_amount":3293.37,"10th_percentile":3293.37,"90th_percentile":3293.37,"count":"1 through 10","methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"median_amount":7168.64,"10th_percentile":7168.62,"90th_percentile":7168.64,"count":"1 through 10","methodology":"percent of total billed charges"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"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":1538.38,"maximum":5623.82,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":5623.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2896.27,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":2811.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2811.91,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":2952.51,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2924.39,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":2811.91,"methodology":"case rate"}]}]},{"description":"DERMABRASION SEGMENTAL FACE","code_information":[{"code":"15781","type":"CPT"}],"standard_charges":[{"minimum":691.26,"maximum":1538.38,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":1382.52,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":712,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":691.26,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":691.26,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":725.82,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":718.91,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":691.26,"methodology":"case rate"}]}]},{"description":"DERMABRASION OTHER THAN FACE","code_information":[{"code":"15782","type":"CPT"}],"standard_charges":[{"minimum":1538.38,"maximum":5623.82,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":5623.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2896.27,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":2811.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2811.91,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":2952.51,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2924.39,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":2811.91,"methodology":"case rate"}]}]},{"description":"DERMABRASION SUPRFL ANY SITE","code_information":[{"code":"15783","type":"CPT"}],"standard_charges":[{"minimum":392.53,"maximum":1538.38,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":785.06,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":404.31,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":392.53,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":392.53,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":412.16,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":408.23,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":392.53,"methodology":"case rate"}]}]},{"description":"ABRASION LESION SINGLE","code_information":[{"code":"15786","type":"CPT"}],"standard_charges":[{"minimum":195.22,"maximum":1538.38,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":390.44,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":201.08,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":195.22,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":195.22,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":204.98,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":203.03,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":195.22,"methodology":"case rate"}]}]},{"description":"ABRASION LESIONS ADD-ON","code_information":[{"code":"15787","type":"CPT"}],"standard_charges":[{"minimum":1538.38,"maximum":1538.38,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"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|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"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":392.53,"maximum":1538.38,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":785.06,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":404.31,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":392.53,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":392.53,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":412.16,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":408.23,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":392.53,"methodology":"case rate"}]}]},{"description":"CHEMICAL PEEL FACE DERMAL","code_information":[{"code":"15789","type":"CPT"}],"standard_charges":[{"minimum":601.41,"maximum":1538.38,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":1202.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":619.45,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":601.41,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":601.41,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":631.48,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":625.47,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":601.41,"methodology":"case rate"}]}]},{"description":"CHEMICAL PEEL NONFACIAL","code_information":[{"code":"15792","type":"CPT"}],"standard_charges":[{"minimum":601.41,"maximum":1538.38,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":1202.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":619.45,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":601.41,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":601.41,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":631.48,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":625.47,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":601.41,"methodology":"case rate"}]}]},{"description":"CHEMICAL PEEL NONFACIAL","code_information":[{"code":"15793","type":"CPT"}],"standard_charges":[{"minimum":392.53,"maximum":1538.38,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":785.06,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":404.31,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":392.53,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":392.53,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":412.16,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":408.23,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":392.53,"methodology":"case rate"}]}]},{"description":"DENTAL AND ORAL DISEASES WITH CC","code_information":[{"code":"158","type":"MS-DRG"}],"standard_charges":[{"minimum":5950.48,"maximum":14163,"setting":"inpatient","payers_information":[{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":14163,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":12664,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":13919.24,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":11771,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13919,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":12839,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":5950.48,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":6942.23,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":6611.64,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":6743.88,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":6743.88,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6743.88,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":7168.41,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":6994.42,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6959.62,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":7307.61,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7133.62,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":6959.62,"methodology":"case rate"}]}]},{"description":"PLASTIC SURGERY NECK","code_information":[{"code":"15819","type":"CPT"}],"standard_charges":[{"minimum":1538.38,"maximum":1538.38,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"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|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"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":1797.18,"maximum":3796,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":3796,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3212,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":3594.36,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":2657.78,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1851.1,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":1797.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1797.18,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":1887.04,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1869.07,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":1797.18,"methodology":"case rate"}]}]},{"description":"REVISION OF LOWER EYELID","code_information":[{"code":"15821","type":"CPT"}],"standard_charges":[{"minimum":1797.18,"maximum":3796,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":3796,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3212,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":3594.36,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":2657.78,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1851.1,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":1797.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1797.18,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":1887.04,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1869.07,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":1797.18,"methodology":"case rate"}]}]},{"description":"REVISION OF UPPER EYELID","code_information":[{"code":"15822","type":"CPT"}],"standard_charges":[{"minimum":1797.18,"maximum":3796,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":3796,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3212,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":3594.36,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":2657.78,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1851.1,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":1797.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1797.18,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":1887.04,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1869.07,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":1797.18,"methodology":"case rate"}]}]},{"description":"REVISION OF UPPER EYELID","code_information":[{"code":"15823","type":"CPT"}],"standard_charges":[{"minimum":1797.18,"maximum":4514,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":4514,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3819,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":3594.36,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":3497.02,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1851.1,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":1797.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1797.18,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":1887.04,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1869.07,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":1797.18,"methodology":"case rate"}]}]},{"description":"REMOVAL OF FOREHEAD WRINKLES","code_information":[{"code":"15824","type":"CPT"}],"standard_charges":[{"minimum":1797.18,"maximum":3796,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":3796,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3212,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":3594.36,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":2657.78,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1851.1,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":1797.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1797.18,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":1887.04,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1869.07,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":1797.18,"methodology":"case rate"}]}]},{"description":"REMOVAL OF NECK WRINKLES","code_information":[{"code":"15825","type":"CPT"}],"standard_charges":[{"minimum":2657.78,"maximum":7193.66,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":3796,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3212,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":7193.66,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":2657.78,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3704.73,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":3596.83,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3596.83,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":3776.67,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3740.7,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":3596.83,"methodology":"case rate"}]}]},{"description":"REMOVAL OF BROW WRINKLES","code_information":[{"code":"15826","type":"CPT"}],"standard_charges":[{"minimum":2657.78,"maximum":7193.66,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":3796,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3212,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":7193.66,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":2657.78,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3704.73,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":3596.83,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3596.83,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":3776.67,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3740.7,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":3596.83,"methodology":"case rate"}]}]},{"description":"REMOVAL OF FACE WRINKLES","code_information":[{"code":"15828","type":"CPT"}],"standard_charges":[{"minimum":2657.78,"maximum":7193.66,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":3796,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3212,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":7193.66,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":2657.78,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3704.73,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":3596.83,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3596.83,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":3776.67,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3740.7,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":3596.83,"methodology":"case rate"}]}]},{"description":"REMOVAL OF SKIN WRINKLES","code_information":[{"code":"15829","type":"CPT"}],"standard_charges":[{"minimum":3497.02,"maximum":7193.66,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":4514,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3819,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":7193.66,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":3497.02,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3704.73,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":3596.83,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3596.83,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":3776.67,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3740.7,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":3596.83,"methodology":"case rate"}]}]},{"description":"HC EXCISE EXCESS SKIN TISSUEABDOMEN","code_information":[{"code":"15830","type":"CPT"},{"code":"0360","type":"RC"}],"standard_charges":[{"minimum":3206.84,"maximum":3206.84,"gross_charge":3524,"discounted_cash":1660.1,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3206.84,"methodology":"fee schedule"}]}]},{"description":"HC EXCISE EXCESS SKIN TISSUEABDOMEN","code_information":[{"code":"15830","type":"CPT"},{"code":"0360","type":"RC"}],"standard_charges":[{"minimum":827.79,"maximum":12814.4,"gross_charge":3524,"discounted_cash":1660.1,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2220.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2220.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2220.12,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":3796,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3212,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":12814.4,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2220.12,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2220.12,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2657.78,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3206.84,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1691.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":2643,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":951.48,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":999.06,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":932.46,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":827.79,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":970.51,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":980.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6599.42,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":6407.2,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6407.2,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":6727.56,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6663.49,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":6407.2,"methodology":"case rate"}]}]},{"description":"EXCISE EXCESSIVE SKIN THIGH","code_information":[{"code":"15832","type":"CPT"}],"standard_charges":[{"minimum":2657.78,"maximum":5623.82,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":3796,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3212,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":5623.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":2657.78,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2896.27,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":2811.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2811.91,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":2952.51,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2924.39,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":2811.91,"methodology":"case rate"}]}]},{"description":"EXCISE EXCESSIVE SKIN LEG","code_information":[{"code":"15833","type":"CPT"}],"standard_charges":[{"minimum":2657.78,"maximum":5623.82,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":3796,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3212,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":5623.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":2657.78,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2896.27,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":2811.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2811.91,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":2952.51,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2924.39,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":2811.91,"methodology":"case rate"}]}]},{"description":"EXCISE EXCESSIVE SKIN HIP","code_information":[{"code":"15834","type":"CPT"}],"standard_charges":[{"minimum":2657.78,"maximum":5623.82,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":3796,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3212,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":5623.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":2657.78,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2896.27,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":2811.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2811.91,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":2952.51,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2924.39,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":2811.91,"methodology":"case rate"}]}]},{"description":"EXCISE EXCESSIVE SKIN BUTTCK","code_information":[{"code":"15835","type":"CPT"}],"standard_charges":[{"minimum":2657.78,"maximum":5623.82,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":3796,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3212,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":5623.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":2657.78,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2896.27,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":2811.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2811.91,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":2952.51,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2924.39,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":2811.91,"methodology":"case rate"}]}]},{"description":"EXCISE EXCESSIVE SKIN ARM","code_information":[{"code":"15836","type":"CPT"}],"standard_charges":[{"minimum":2657.78,"maximum":5623.82,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":3796,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3212,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":5623.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":2657.78,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2896.27,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":2811.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2811.91,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":2952.51,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2924.39,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":2811.91,"methodology":"case rate"}]}]},{"description":"EXCISE EXCESS SKIN ARM/HAND","code_information":[{"code":"15837","type":"CPT"}],"standard_charges":[{"minimum":1538.38,"maximum":5623.82,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":5623.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2896.27,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":2811.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2811.91,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":2952.51,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2924.39,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":2811.91,"methodology":"case rate"}]}]},{"description":"EXCISE EXCESS SKIN FAT PAD","code_information":[{"code":"15838","type":"CPT"}],"standard_charges":[{"minimum":1538.38,"maximum":5623.82,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":5623.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2896.27,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":2811.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2811.91,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":2952.51,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2924.39,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":2811.91,"methodology":"case rate"}]}]},{"description":"EXCISE EXCESS SKIN  TISSUE","code_information":[{"code":"15839","type":"CPT"}],"standard_charges":[{"minimum":2657.78,"maximum":5623.82,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":3796,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3212,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":5623.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":2657.78,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2896.27,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":2811.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2811.91,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":2952.51,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2924.39,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":2811.91,"methodology":"case rate"}]}]},{"description":"NERVE PALSY FASCIAL GRAFT","code_information":[{"code":"15840","type":"CPT"}],"standard_charges":[{"minimum":3078.06,"maximum":7193.66,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":4157,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3517,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":7193.66,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":3078.06,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3704.73,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":3596.83,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3596.83,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":3776.67,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3740.7,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":3596.83,"methodology":"case rate"}]}]},{"description":"NERVE PALSY MUSCLE GRAFT","code_information":[{"code":"15841","type":"CPT"}],"standard_charges":[{"minimum":3078.06,"maximum":7193.66,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":4157,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3517,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":7193.66,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":3078.06,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3704.73,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":3596.83,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3596.83,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":3776.67,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3740.7,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":3596.83,"methodology":"case rate"}]}]},{"description":"NERVE PALSY MICROSURG GRAFT","code_information":[{"code":"15842","type":"CPT"}],"standard_charges":[{"minimum":1797.18,"maximum":3594.36,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":3594.36,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":2657.78,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1851.1,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":1797.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1797.18,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":1887.04,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1869.07,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":1797.18,"methodology":"case rate"}]}]},{"description":"SKIN AND MUSCLE REPAIR FACE","code_information":[{"code":"15845","type":"CPT"}],"standard_charges":[{"minimum":3078.06,"maximum":7193.66,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":4157,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3517,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":7193.66,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":3078.06,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3704.73,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":3596.83,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3596.83,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":3776.67,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3740.7,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":3596.83,"methodology":"case rate"}]}]},{"description":"EXC SKIN ABD ADD-ON","code_information":[{"code":"15847","type":"CPT"}],"standard_charges":[{"minimum":2657.78,"maximum":3796,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":3796,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3212,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":2657.78,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"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":1538.38,"maximum":3594.36,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2152,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":1821,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":3594.36,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1851.1,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":1797.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1797.18,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":1887.04,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1869.07,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":1797.18,"methodology":"case rate"}]}]},{"description":"DRESSING CHANGE W/ANESTHESIA","code_information":[{"code":"15852","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":141.05,"maximum":141.05,"gross_charge":155,"discounted_cash":73.02,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":141.05,"methodology":"fee schedule"}]}]},{"description":"DRESSING CHANGE W/ANESTHESIA","code_information":[{"code":"15852","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":36.41,"maximum":1538.38,"gross_charge":155,"discounted_cash":73.02,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":97.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":97.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":97.65,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":1202.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":97.65,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":97.65,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":141.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":74.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":116.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":41.85,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":43.95,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":41.02,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":36.41,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":42.69,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":43.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":619.45,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":601.41,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":601.41,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":631.48,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":625.47,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":601.41,"methodology":"case rate"}]}]},{"description":"REMOVAL SUTURES/STAPLES NOT REQUIRING ANESTHESIA","code_information":[{"code":"15853","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":219.31,"maximum":219.31,"gross_charge":241,"discounted_cash":113.54,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":219.31,"methodology":"fee schedule"}]}]},{"description":"REMOVAL SUTURES/STAPLES NOT REQUIRING ANESTHESIA","code_information":[{"code":"15853","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":56.62,"maximum":536,"gross_charge":241,"discounted_cash":113.54,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":151.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":151.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":151.83,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":127.73,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":113.27,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":151.83,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":151.83,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":219.31,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":536,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":175.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":65.07,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":68.33,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":63.77,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":56.62,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":66.38,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":67.03,"methodology":"fee schedule"}]}]},{"description":"REMOVAL SUTURES AND STAPLES NOT REQUIRING ANESTHESIA","code_information":[{"code":"15854","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":285.74,"maximum":285.74,"gross_charge":314,"discounted_cash":147.93,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":285.74,"methodology":"fee schedule"}]}]},{"description":"REMOVAL SUTURES AND STAPLES NOT REQUIRING ANESTHESIA","code_information":[{"code":"15854","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":73.76,"maximum":536,"gross_charge":314,"discounted_cash":147.93,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":197.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":197.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":197.82,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":166.42,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":147.58,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":197.82,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":197.82,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":285.74,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":536,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":229.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":84.78,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":89.02,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":83.09,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":73.76,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":86.48,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":87.33,"methodology":"fee schedule"}]}]},{"description":"TEST FOR BLOOD FLOW IN GRAFT","code_information":[{"code":"15860","type":"CPT"}],"standard_charges":[{"minimum":392.05,"maximum":1538.38,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":784.1,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":403.81,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":392.05,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":392.05,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":411.65,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":407.73,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":392.05,"methodology":"case rate"}]}]},{"description":"SUCTION LIPECTOMY HEADNECK","code_information":[{"code":"15876","type":"CPT"}],"standard_charges":[{"minimum":2657.78,"maximum":7193.66,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":3796,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3212,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":7193.66,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":2657.78,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3704.73,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":3596.83,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3596.83,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":3776.67,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3740.7,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":3596.83,"methodology":"case rate"}]}]},{"description":"SUCTION LIPECTOMY TRUNK","code_information":[{"code":"15877","type":"CPT"}],"standard_charges":[{"minimum":2657.78,"maximum":7193.66,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":3796,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3212,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":7193.66,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":2657.78,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3704.73,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":3596.83,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3596.83,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":3776.67,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3740.7,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":3596.83,"methodology":"case rate"}]}]},{"description":"SUCTION LIPECTOMY UPR EXTREM","code_information":[{"code":"15878","type":"CPT"}],"standard_charges":[{"minimum":1797.18,"maximum":3796,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":3796,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3212,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":3594.36,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":2657.78,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1851.1,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":1797.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1797.18,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":1887.04,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1869.07,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":1797.18,"methodology":"case rate"}]}]},{"description":"SUCTION LIPECTOMY LWR EXTREM","code_information":[{"code":"15879","type":"CPT"}],"standard_charges":[{"minimum":2657.78,"maximum":7193.66,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":3796,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3212,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":7193.66,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":2657.78,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3704.73,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":3596.83,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3596.83,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":3776.67,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3740.7,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":3596.83,"methodology":"case rate"}]}]},{"description":"DENTAL AND ORAL DISEASES WITHOUT CC/MCC","code_information":[{"code":"159","type":"MS-DRG"}],"standard_charges":[{"minimum":4260.34,"maximum":9965.7,"setting":"inpatient","payers_information":[{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":9932,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":8881,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":9965.7,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":8255,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9761,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":9004,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":4260.34,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":4970.4,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":4733.71,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":4828.39,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":4828.39,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4828.39,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5132.34,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":5007.77,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":4982.85,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":5232,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":5107.43,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":4982.85,"methodology":"case rate"}]}]},{"description":"REMOVAL OF TAIL BONE ULCER","code_information":[{"code":"15920","type":"CPT"}],"standard_charges":[{"minimum":2657.78,"maximum":5623.82,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":3796,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3212,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":5623.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":2657.78,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2896.27,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":2811.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2811.91,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":2952.51,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2924.39,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":2811.91,"methodology":"case rate"}]}]},{"description":"REMOVAL OF TAIL BONE ULCER","code_information":[{"code":"15922","type":"CPT"}],"standard_charges":[{"minimum":3078.06,"maximum":7193.66,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":4157,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3517,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":7193.66,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":3078.06,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3704.73,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":3596.83,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3596.83,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":3776.67,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3740.7,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":3596.83,"methodology":"case rate"}]}]},{"description":"REMOVE SACRUM PRESSURE SORE","code_information":[{"code":"15931","type":"CPT"}],"standard_charges":[{"minimum":2657.78,"maximum":5623.82,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":3796,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3212,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":5623.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":2657.78,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2896.27,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":2811.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2811.91,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":2952.51,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2924.39,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":2811.91,"methodology":"case rate"}]}]},{"description":"REMOVE SACRUM PRESSURE SORE","code_information":[{"code":"15933","type":"CPT"}],"standard_charges":[{"minimum":2657.78,"maximum":5623.82,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":3796,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3212,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":5623.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":2657.78,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2896.27,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":2811.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2811.91,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":2952.51,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2924.39,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":2811.91,"methodology":"case rate"}]}]},{"description":"REMOVE SACRUM PRESSURE SORE","code_information":[{"code":"15934","type":"CPT"}],"standard_charges":[{"minimum":2657.78,"maximum":7193.66,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":3796,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3212,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":7193.66,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":2657.78,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3704.73,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":3596.83,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3596.83,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":3776.67,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3740.7,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":3596.83,"methodology":"case rate"}]}]},{"description":"REMOVE SACRUM PRESSURE SORE","code_information":[{"code":"15935","type":"CPT"}],"standard_charges":[{"minimum":3078.06,"maximum":7193.66,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":4157,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3517,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":7193.66,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":3078.06,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3704.73,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":3596.83,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3596.83,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":3776.67,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3740.7,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":3596.83,"methodology":"case rate"}]}]},{"description":"REMOVE SACRUM PRESSURE SORE","code_information":[{"code":"15936","type":"CPT"}],"standard_charges":[{"minimum":1797.18,"maximum":4157,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":4157,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3517,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":3594.36,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":3078.06,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1851.1,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":1797.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1797.18,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":1887.04,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1869.07,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":1797.18,"methodology":"case rate"}]}]},{"description":"REMOVE SACRUM PRESSURE SORE","code_information":[{"code":"15937","type":"CPT"}],"standard_charges":[{"minimum":1797.18,"maximum":4157,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":4157,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3517,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":3594.36,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":3078.06,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1851.1,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":1797.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1797.18,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":1887.04,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1869.07,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":1797.18,"methodology":"case rate"}]}]},{"description":"REMOVE HIP PRESSURE SORE","code_information":[{"code":"15940","type":"CPT"}],"standard_charges":[{"minimum":2657.78,"maximum":5623.82,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":3796,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3212,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":5623.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":2657.78,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2896.27,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":2811.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2811.91,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":2952.51,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2924.39,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":2811.91,"methodology":"case rate"}]}]},{"description":"REMOVE HIP PRESSURE SORE","code_information":[{"code":"15941","type":"CPT"}],"standard_charges":[{"minimum":2657.78,"maximum":5623.82,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":3796,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3212,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":5623.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":2657.78,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2896.27,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":2811.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2811.91,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":2952.51,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2924.39,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":2811.91,"methodology":"case rate"}]}]},{"description":"REMOVE HIP PRESSURE SORE","code_information":[{"code":"15944","type":"CPT"}],"standard_charges":[{"minimum":2657.78,"maximum":7193.66,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":3796,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3212,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":7193.66,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":2657.78,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3704.73,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":3596.83,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3596.83,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":3776.67,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3740.7,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":3596.83,"methodology":"case rate"}]}]},{"description":"REMOVE HIP PRESSURE SORE","code_information":[{"code":"15945","type":"CPT"}],"standard_charges":[{"minimum":1797.18,"maximum":4157,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":4157,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3517,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":3594.36,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":3078.06,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1851.1,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":1797.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1797.18,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":1887.04,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1869.07,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":1797.18,"methodology":"case rate"}]}]},{"description":"REMOVE HIP PRESSURE SORE","code_information":[{"code":"15946","type":"CPT"}],"standard_charges":[{"minimum":1797.18,"maximum":4157,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":4157,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3517,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":3594.36,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":3078.06,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1851.1,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":1797.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1797.18,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":1887.04,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1869.07,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":1797.18,"methodology":"case rate"}]}]},{"description":"REMOVE THIGH PRESSURE SORE","code_information":[{"code":"15950","type":"CPT"}],"standard_charges":[{"minimum":1591.85,"maximum":3796,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":3796,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3212,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":3183.7,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":2657.78,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1639.61,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":1591.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1591.85,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":1671.44,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1655.52,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":1591.85,"methodology":"case rate"}]}]},{"description":"REMOVE THIGH PRESSURE SORE","code_information":[{"code":"15951","type":"CPT"}],"standard_charges":[{"minimum":2811.91,"maximum":5623.82,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":4157,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3517,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":5623.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":3078.06,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2896.27,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":2811.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2811.91,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":2952.51,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2924.39,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":2811.91,"methodology":"case rate"}]}]},{"description":"REMOVE THIGH PRESSURE SORE","code_information":[{"code":"15952","type":"CPT"}],"standard_charges":[{"minimum":1797.18,"maximum":3796,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":3796,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3212,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":3594.36,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":2657.78,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1851.1,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":1797.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1797.18,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":1887.04,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1869.07,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":1797.18,"methodology":"case rate"}]}]},{"description":"REMOVE THIGH PRESSURE SORE","code_information":[{"code":"15953","type":"CPT"}],"standard_charges":[{"minimum":3078.06,"maximum":7193.66,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":4157,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3517,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":7193.66,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":3078.06,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3704.73,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":3596.83,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3596.83,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":3776.67,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3740.7,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":3596.83,"methodology":"case rate"}]}]},{"description":"REMOVE THIGH PRESSURE SORE","code_information":[{"code":"15956","type":"CPT"}],"standard_charges":[{"minimum":1797.18,"maximum":3796,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":3796,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3212,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":3594.36,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":2657.78,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1851.1,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":1797.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1797.18,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":1887.04,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1869.07,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":1797.18,"methodology":"case rate"}]}]},{"description":"REMOVE THIGH PRESSURE SORE","code_information":[{"code":"15958","type":"CPT"}],"standard_charges":[{"minimum":3078.06,"maximum":7193.66,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":4157,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3517,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":7193.66,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":3078.06,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3704.73,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":3596.83,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3596.83,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":3776.67,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3740.7,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":3596.83,"methodology":"case rate"}]}]},{"description":"REMOVAL OF PRESSURE SORE","code_information":[{"code":"15999","type":"CPT"}],"standard_charges":[{"minimum":691.26,"maximum":1538.38,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":1382.52,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":712,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":691.26,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":691.26,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":725.82,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":718.91,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":691.26,"methodology":"case rate"}]}]},{"description":"HC INIT TX 1ST DEGR BURN","code_information":[{"code":"16000","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":394.94,"maximum":394.94,"gross_charge":434,"discounted_cash":204.46,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":394.94,"methodology":"fee schedule"}]}]},{"description":"HC INIT TX 1ST DEGR BURN","code_information":[{"code":"16000","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":101.95,"maximum":1538.38,"gross_charge":434,"discounted_cash":204.46,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":273.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":273.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":273.42,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":230.02,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":203.98,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":390.44,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":273.42,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":273.42,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":394.94,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":208.32,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":325.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":117.18,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":123.04,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":114.84,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":101.95,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":119.53,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":120.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":201.08,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":195.22,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":195.22,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":204.98,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":203.03,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":195.22,"methodology":"case rate"}]}]},{"description":"HC DRESS/DEBRID P-THICK BURN S","code_information":[{"code":"16020","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":551.46,"maximum":551.46,"gross_charge":606,"discounted_cash":285.48,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":551.46,"methodology":"fee schedule"}]}]},{"description":"HC DRESS/DEBRID P-THICK BURN S","code_information":[{"code":"16020","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":142.35,"maximum":1538.38,"gross_charge":606,"discounted_cash":285.48,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":381.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":381.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":381.78,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":321.18,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":284.82,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":390.44,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":381.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":381.78,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":551.46,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":290.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":454.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":163.62,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":171.81,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":160.35,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":142.35,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":166.9,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":168.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":201.08,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":195.22,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":195.22,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":204.98,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":203.03,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":195.22,"methodology":"case rate"}]}]},{"description":"HC DRESS/DEBRID P-THICK BURN M","code_information":[{"code":"16025","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":563.29,"maximum":563.29,"gross_charge":619,"discounted_cash":291.61,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":563.29,"methodology":"fee schedule"}]}]},{"description":"HC DRESS/DEBRID P-THICK BURN M","code_information":[{"code":"16025","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":145.41,"maximum":2376,"gross_charge":619,"discounted_cash":291.61,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":389.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":389.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":389.97,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2376,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":2011,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":390.44,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":389.97,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":389.97,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":563.29,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":297.12,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":464.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":167.13,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":175.49,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":163.79,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":145.41,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":170.48,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":172.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":201.08,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":195.22,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":195.22,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":204.98,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":203.03,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":195.22,"methodology":"case rate"}]}]},{"description":"HC DRESS/DEBRID P-THICK BURN L","code_information":[{"code":"16030","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":667.94,"maximum":667.94,"gross_charge":734,"discounted_cash":345.78,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":667.94,"methodology":"fee schedule"}]}]},{"description":"HC DRESS/DEBRID P-THICK BURN L","code_information":[{"code":"16030","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":172.42,"maximum":2376,"gross_charge":734,"discounted_cash":345.78,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":462.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":462.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":462.42,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2376,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":2011,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":785.06,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":462.42,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":462.42,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":667.94,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":352.32,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":550.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":198.18,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":208.09,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":194.22,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":172.42,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":202.15,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":204.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":404.31,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":392.53,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":392.53,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":412.16,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":408.23,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":392.53,"methodology":"case rate"}]}]},{"description":"HC ESCHAROTOMY INITIAL INCISION","code_information":[{"code":"16035","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":470.47,"maximum":470.47,"gross_charge":517,"discounted_cash":243.55,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":470.47,"methodology":"fee schedule"}]}]},{"description":"HC ESCHAROTOMY INITIAL INCISION","code_information":[{"code":"16035","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":121.45,"maximum":2152,"gross_charge":517,"discounted_cash":243.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":325.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":325.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":325.71,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2152,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":1821,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":785.06,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":325.71,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":325.71,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":470.47,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":248.16,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":387.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":139.59,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":146.57,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":136.8,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":121.45,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":142.39,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":143.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":404.31,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":392.53,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":392.53,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":412.16,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":408.23,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":392.53,"methodology":"case rate"}]}]},{"description":"ESCHAROTOMY ADDL INCISION","code_information":[{"code":"16036","type":"CPT"}],"standard_charges":[{"minimum":1538.38,"maximum":1538.38,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"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|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"MAJOR CHEST PROCEDURES WITH MCC","code_information":[{"code":"163","type":"MS-DRG"}],"standard_charges":[{"minimum":28016.19,"maximum":69401,"setting":"inpatient","payers_information":[{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":69401,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":62058,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":65534.92,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":57682,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":68207,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":62916,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":28016.19,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":32685.55,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":31129.09,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":31751.68,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":31751.68,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":31751.68,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":33750.49,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":32931.3,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":32767.46,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":34405.84,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":33586.65,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":32767.46,"methodology":"case rate"}]}]},{"description":"MAJOR CHEST PROCEDURES WITH CC","code_information":[{"code":"164","type":"MS-DRG"}],"standard_charges":[{"minimum":15432.13,"maximum":37898,"setting":"inpatient","payers_information":[{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":37898,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":33889,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":36098.54,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":31499,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":37247,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":34357,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":15432.13,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":18004.16,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":17146.81,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":17489.75,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":17489.75,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":17489.75,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":18590.75,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":18139.52,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":18049.27,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":18951.74,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":18500.51,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":18049.27,"methodology":"case rate"}]}]},{"description":"MAJOR CHEST PROCEDURES WITHOUT CC/MCC","code_information":[{"code":"165","type":"MS-DRG"}],"standard_charges":[{"minimum":11504.51,"maximum":28066,"setting":"inpatient","payers_information":[{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":28066,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":25097,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":26911.1,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":23327,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":27583,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":25444,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":11504.51,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":13421.92,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":12782.78,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":13038.44,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":13038.44,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13038.44,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":13859.22,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":13522.83,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":13455.55,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":14128.33,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":13791.94,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":13455.55,"methodology":"case rate"}]}]},{"description":"OTHER RESPIRATORY SYSTEM O.R. PROCEDURES WITH MCC","code_information":[{"code":"166","type":"MS-DRG"}],"standard_charges":[{"minimum":23451.59,"maximum":57974,"setting":"inpatient","payers_information":[{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":57974,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":51840,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":54857.5,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":48185,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":56977,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":52557,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":23451.59,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":27360.19,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":26057.32,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":26578.47,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":26578.47,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":26578.47,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":28251.62,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":27565.9,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":27428.75,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":28800.19,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":28114.47,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":27428.75,"methodology":"case rate"}]}]},{"description":"OTHER RESPIRATORY SYSTEM O.R. PROCEDURES WITH CC","code_information":[{"code":"167","type":"MS-DRG"}],"standard_charges":[{"minimum":11283.16,"maximum":27512,"setting":"inpatient","payers_information":[{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":27512,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":24601,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":26393.34,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":22867,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":27039,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":24941,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":11283.16,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":13163.69,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":12536.84,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":12787.58,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":12787.58,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12787.58,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":13592.58,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":13262.66,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":13196.67,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":13856.51,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":13526.59,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":13196.67,"methodology":"case rate"}]}]},{"description":"OTHER RESPIRATORY SYSTEM O.R. PROCEDURES WITHOUT CC/MCC","code_information":[{"code":"168","type":"MS-DRG"}],"standard_charges":[{"minimum":8436.38,"maximum":20386,"setting":"inpatient","payers_information":[{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":20386,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":18229,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":19734.2,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":16943,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":20035,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":18481,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":8436.38,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":9842.44,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":9373.75,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":9561.23,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":9561.23,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":9561.23,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":10163.12,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":9916.44,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":9867.1,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":10360.46,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":10113.78,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":9867.1,"methodology":"case rate"}]}]},{"description":"HC DESTRUC BENIGN/PREMALFIRST LESION","code_information":[{"code":"17000","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":157.43,"maximum":157.43,"gross_charge":173,"discounted_cash":81.5,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":157.43,"methodology":"fee schedule"}]}]},{"description":"HC DESTRUC BENIGN/PREMALFIRST LESION","code_information":[{"code":"17000","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":40.64,"maximum":1538.38,"gross_charge":173,"discounted_cash":81.5,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":108.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":108.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":108.99,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":91.69,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":81.31,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":390.44,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":108.99,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":108.99,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":157.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":83.04,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":129.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":46.71,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":49.05,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":45.78,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":40.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":47.65,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":48.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":201.08,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":195.22,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":195.22,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":204.98,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":203.03,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":195.22,"methodology":"case rate"}]}]},{"description":"DESTRUCT PREMALG LES 2-14","code_information":[{"code":"17003","type":"CPT"}],"standard_charges":[{"minimum":1538.38,"maximum":1538.38,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"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|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"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":392.53,"maximum":2152,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2152,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":1821,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":785.06,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":404.31,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":392.53,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":392.53,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":412.16,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":408.23,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":392.53,"methodology":"case rate"}]}]},{"description":"DESTRUCTION OF SKIN LESIONS","code_information":[{"code":"17106","type":"CPT"}],"standard_charges":[{"minimum":392.53,"maximum":1538.38,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":785.06,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":404.31,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":392.53,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":392.53,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":412.16,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":408.23,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":392.53,"methodology":"case rate"}]}]},{"description":"DESTRUCTION OF SKIN LESIONS","code_information":[{"code":"17107","type":"CPT"}],"standard_charges":[{"minimum":601.41,"maximum":1538.38,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":1202.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":619.45,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":601.41,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":601.41,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":631.48,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":625.47,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":601.41,"methodology":"case rate"}]}]},{"description":"DESTRUCTION OF SKIN LESIONS","code_information":[{"code":"17108","type":"CPT"}],"standard_charges":[{"minimum":1538.38,"maximum":3594.36,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":3594.36,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1851.1,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":1797.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1797.18,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":1887.04,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1869.07,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":1797.18,"methodology":"case rate"}]}]},{"description":"HC DESTRUCTION BENIGN LESIONS UP TO 14","code_information":[{"code":"17110","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":273.91,"maximum":273.91,"gross_charge":301,"discounted_cash":141.8,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":273.91,"methodology":"fee schedule"}]}]},{"description":"HC DESTRUCTION BENIGN LESIONS UP TO 14","code_information":[{"code":"17110","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":70.71,"maximum":2152,"gross_charge":301,"discounted_cash":141.8,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":189.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":189.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":189.63,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2152,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":1821,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":390.44,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":189.63,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":189.63,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":273.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":144.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":225.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":81.27,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":85.34,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":79.65,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":70.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":82.9,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":83.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":201.08,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":195.22,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":195.22,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":204.98,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":203.03,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":195.22,"methodology":"case rate"}]}]},{"description":"DESTRUCT LESION 15 OR MORE","code_information":[{"code":"17111","type":"CPT"}],"standard_charges":[{"minimum":195.22,"maximum":1538.38,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":390.44,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":201.08,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":195.22,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":195.22,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":204.98,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":203.03,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":195.22,"methodology":"case rate"}]}]},{"description":"HC CHEM CAUT GRANULATION TISS","code_information":[{"code":"17250","type":"CPT"},{"code":"0761","type":"RC"}],"standard_charges":[{"minimum":255.71,"maximum":255.71,"gross_charge":281,"discounted_cash":132.38,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":255.71,"methodology":"fee schedule"}]}]},{"description":"HC CHEM CAUT GRANULATION TISS","code_information":[{"code":"17250","type":"CPT"},{"code":"0761","type":"RC"}],"standard_charges":[{"minimum":66.01,"maximum":1538.38,"gross_charge":281,"discounted_cash":132.38,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":177.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":177.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":177.03,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":390.44,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":177.03,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":177.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":255.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":134.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":210.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":75.87,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":79.67,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":74.36,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":66.01,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":77.39,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":78.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":201.08,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":195.22,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":195.22,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":204.98,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":203.03,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":195.22,"methodology":"case rate"}]}]},{"description":"DESTRUCTION OF SKIN LESIONS","code_information":[{"code":"17260","type":"CPT"}],"standard_charges":[{"minimum":195.22,"maximum":1538.38,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":390.44,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":201.08,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":195.22,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":195.22,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":204.98,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":203.03,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":195.22,"methodology":"case rate"}]}]},{"description":"DESTRUCTION OF SKIN LESIONS","code_information":[{"code":"17261","type":"CPT"}],"standard_charges":[{"minimum":195.22,"maximum":1538.38,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":390.44,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":201.08,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":195.22,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":195.22,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":204.98,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":203.03,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":195.22,"methodology":"case rate"}]}]},{"description":"DESTRUCTION OF SKIN LESIONS","code_information":[{"code":"17262","type":"CPT"}],"standard_charges":[{"minimum":195.22,"maximum":1538.38,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":390.44,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":201.08,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":195.22,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":195.22,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":204.98,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":203.03,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":195.22,"methodology":"case rate"}]}]},{"description":"DESTRUCTION OF SKIN LESIONS","code_information":[{"code":"17263","type":"CPT"}],"standard_charges":[{"minimum":195.22,"maximum":1538.38,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":390.44,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":201.08,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":195.22,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":195.22,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":204.98,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":203.03,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":195.22,"methodology":"case rate"}]}]},{"description":"DESTRUCTION OF SKIN LESIONS","code_information":[{"code":"17264","type":"CPT"}],"standard_charges":[{"minimum":392.53,"maximum":1538.38,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":785.06,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":404.31,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":392.53,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":392.53,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":412.16,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":408.23,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":392.53,"methodology":"case rate"}]}]},{"description":"DESTRUCTION OF SKIN LESIONS","code_information":[{"code":"17266","type":"CPT"}],"standard_charges":[{"minimum":392.53,"maximum":1538.38,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":785.06,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":404.31,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":392.53,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":392.53,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":412.16,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":408.23,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":392.53,"methodology":"case rate"}]}]},{"description":"DESTRUCTION OF SKIN LESIONS","code_information":[{"code":"17270","type":"CPT"}],"standard_charges":[{"minimum":195.22,"maximum":1538.38,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":390.44,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":201.08,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":195.22,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":195.22,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":204.98,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":203.03,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":195.22,"methodology":"case rate"}]}]},{"description":"DESTRUCTION OF SKIN LESIONS","code_information":[{"code":"17271","type":"CPT"}],"standard_charges":[{"minimum":195.22,"maximum":1538.38,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":390.44,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":201.08,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":195.22,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":195.22,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":204.98,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":203.03,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":195.22,"methodology":"case rate"}]}]},{"description":"DESTRUCTION OF SKIN LESIONS","code_information":[{"code":"17272","type":"CPT"}],"standard_charges":[{"minimum":195.22,"maximum":1538.38,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":390.44,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":201.08,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":195.22,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":195.22,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":204.98,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":203.03,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":195.22,"methodology":"case rate"}]}]},{"description":"DESTRUCTION OF SKIN LESIONS","code_information":[{"code":"17273","type":"CPT"}],"standard_charges":[{"minimum":392.53,"maximum":1538.38,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":785.06,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":404.31,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":392.53,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":392.53,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":412.16,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":408.23,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":392.53,"methodology":"case rate"}]}]},{"description":"DESTRUCTION OF SKIN LESIONS","code_information":[{"code":"17274","type":"CPT"}],"standard_charges":[{"minimum":392.53,"maximum":1538.38,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":785.06,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":404.31,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":392.53,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":392.53,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":412.16,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":408.23,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":392.53,"methodology":"case rate"}]}]},{"description":"DESTRUCTION OF SKIN LESIONS","code_information":[{"code":"17276","type":"CPT"}],"standard_charges":[{"minimum":392.53,"maximum":1538.38,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":785.06,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":404.31,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":392.53,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":392.53,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":412.16,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":408.23,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":392.53,"methodology":"case rate"}]}]},{"description":"DESTRUCTION OF SKIN LESIONS","code_information":[{"code":"17280","type":"CPT"}],"standard_charges":[{"minimum":195.22,"maximum":1538.38,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":390.44,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":201.08,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":195.22,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":195.22,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":204.98,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":203.03,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":195.22,"methodology":"case rate"}]}]},{"description":"DESTRUCTION OF SKIN LESIONS","code_information":[{"code":"17281","type":"CPT"}],"standard_charges":[{"minimum":195.22,"maximum":1538.38,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":390.44,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":201.08,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":195.22,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":195.22,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":204.98,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":203.03,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":195.22,"methodology":"case rate"}]}]},{"description":"DESTRUCTION OF SKIN LESIONS","code_information":[{"code":"17282","type":"CPT"}],"standard_charges":[{"minimum":195.22,"maximum":1538.38,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":390.44,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":201.08,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":195.22,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":195.22,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":204.98,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":203.03,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":195.22,"methodology":"case rate"}]}]},{"description":"DESTRUCTION OF SKIN LESIONS","code_information":[{"code":"17283","type":"CPT"}],"standard_charges":[{"minimum":392.53,"maximum":1538.38,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":785.06,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":404.31,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":392.53,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":392.53,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":412.16,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":408.23,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":392.53,"methodology":"case rate"}]}]},{"description":"DESTRUCTION OF SKIN LESIONS","code_information":[{"code":"17284","type":"CPT"}],"standard_charges":[{"minimum":601.41,"maximum":1538.38,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":1202.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":619.45,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":601.41,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":601.41,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":631.48,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":625.47,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":601.41,"methodology":"case rate"}]}]},{"description":"DESTRUCTION OF SKIN LESIONS","code_information":[{"code":"17286","type":"CPT"}],"standard_charges":[{"minimum":601.41,"maximum":1538.38,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":1202.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":619.45,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":601.41,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":601.41,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":631.48,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":625.47,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":601.41,"methodology":"case rate"}]}]},{"description":"ULTRASOUND ACCELERATED AND OTHER THROMBOLYSIS WITH PRINCIPAL DIAGNOSIS PULMONARY EMBOLISM","code_information":[{"code":"173","type":"MS-DRG"}],"standard_charges":[{"minimum":18749.87,"maximum":46204,"setting":"inpatient","payers_information":[{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":46204,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":41316,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":43859.32,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":38402,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":45409,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":41886,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":18749.87,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":21874.84,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":20833.18,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":21249.85,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":21249.85,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":21249.85,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":22587.55,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":22039.31,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":21929.66,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":23026.15,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":22477.91,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":21929.66,"methodology":"case rate"}]}]},{"description":"MOHS 1 STAGE H/N/HF/G","code_information":[{"code":"17311","type":"CPT"}],"standard_charges":[{"minimum":601.41,"maximum":1538.38,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":1202.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":619.45,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":601.41,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":601.41,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":631.48,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":625.47,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":601.41,"methodology":"case rate"}]}]},{"description":"MOHS ADDL STAGE","code_information":[{"code":"17312","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"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|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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":52,"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":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"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":601.41,"maximum":1538.38,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":1202.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":619.45,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":601.41,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":601.41,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":631.48,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":625.47,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":601.41,"methodology":"case rate"}]}]},{"description":"MOHS ADDL STAGE T/A/L","code_information":[{"code":"17314","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"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|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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":52,"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":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"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":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"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|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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":52,"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":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"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":58.36,"maximum":1538.38,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":116.72,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":60.11,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":58.36,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":58.36,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":61.28,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":60.69,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":58.36,"methodology":"case rate"}]}]},{"description":"SKIN PEEL THERAPY","code_information":[{"code":"17360","type":"CPT"}],"standard_charges":[{"minimum":195.22,"maximum":1538.38,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":390.44,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":201.08,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":195.22,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":195.22,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":204.98,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":203.03,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":195.22,"methodology":"case rate"}]}]},{"description":"HAIR REMOVAL BY ELECTROLYSIS","code_information":[{"code":"17380","type":"CPT"}],"standard_charges":[{"minimum":601.41,"maximum":1538.38,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":1202.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":619.45,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":601.41,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":601.41,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":631.48,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":625.47,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":601.41,"methodology":"case rate"}]}]},{"description":"PULMONARY EMBOLISM WITH MCC OR ACUTE COR PULMONALE","code_information":[{"code":"175","type":"MS-DRG"}],"standard_charges":[{"minimum":8768.39,"maximum":21217,"setting":"inpatient","payers_information":[{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":21217,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":18972,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":20510.84,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":17634,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":20852,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":19234,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":8768.39,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":10229.79,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":9742.65,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":9937.51,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":9937.51,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":9937.51,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":10563.09,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":10306.7,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":10255.42,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":10768.2,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":10511.81,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":10255.42,"methodology":"case rate"}]}]},{"description":"PULMONARY EMBOLISM WITHOUT MCC","code_information":[{"code":"176","type":"MS-DRG"}],"standard_charges":[{"minimum":5192.03,"maximum":12264,"setting":"inpatient","payers_information":[{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":12264,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":10966,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":12145.08,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":10193,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12053,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":11118,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":5192.03,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":6057.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":5768.92,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":5884.3,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":5884.3,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5884.3,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6254.72,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":6102.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6072.54,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":6376.17,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6224.36,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":6072.54,"methodology":"case rate"}]}]},{"description":"RESPIRATORY INFECTIONS AND INFLAMMATIONS WITH MCC","code_information":[{"code":"177","type":"MS-DRG"}],"standard_charges":[{"minimum":10015.85,"maximum":24340,"setting":"inpatient","payers_information":[{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":24340,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":21765,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":23428.88,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":20230,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":23921,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":22065,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":10015.85,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":11685.16,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":11128.72,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":11351.3,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":11351.3,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11351.3,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":12065.88,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":11773.02,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":11714.44,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":12300.17,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":12007.31,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":11714.44,"methodology":"case rate"}]}]},{"description":"RESPIRATORY INFECTIONS AND INFLAMMATIONS WITH CC","code_information":[{"code":"178","type":"MS-DRG"}],"standard_charges":[{"minimum":6260.25,"maximum":14938,"setting":"inpatient","payers_information":[{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":14938,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":13358,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":14643.84,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":12416,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14681,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":13542,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":6260.25,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":7303.63,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":6955.83,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":7094.95,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":7094.95,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":7094.95,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":7541.58,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":7358.53,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7321.92,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":7688.02,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7504.97,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":7321.92,"methodology":"case rate"}]}]},{"description":"RESPIRATORY INFECTIONS AND INFLAMMATIONS WITHOUT CC/MCC","code_information":[{"code":"179","type":"MS-DRG"}],"standard_charges":[{"minimum":4922.57,"maximum":11589,"setting":"inpatient","payers_information":[{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":11589,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":10363,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":11514.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":9632,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11390,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":10506,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":4922.57,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":5743,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":5469.52,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":5578.92,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":5578.92,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5578.92,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5930.11,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":5786.17,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5757.38,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":6045.25,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":5901.32,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":5757.38,"methodology":"case rate"}]}]},{"description":"UNLISTED PROCEDURE SKIN BX","code_information":[{"code":"17999","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":389.48,"maximum":389.48,"gross_charge":428,"discounted_cash":201.63,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":389.48,"methodology":"fee schedule"}]}]},{"description":"UNLISTED PROCEDURE SKIN BX","code_information":[{"code":"17999","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":100.54,"maximum":1538.38,"gross_charge":428,"discounted_cash":201.63,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":269.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":269.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":269.64,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":390.44,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":269.64,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":269.64,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":389.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":205.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":321,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":115.56,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":121.34,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":113.25,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":100.54,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":117.88,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":119.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":201.08,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":195.22,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":195.22,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":204.98,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":203.03,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":195.22,"methodology":"case rate"}]}]},{"description":"RESPIRATORY NEOPLASMS WITH MCC","code_information":[{"code":"180","type":"MS-DRG"}],"standard_charges":[{"minimum":10805.59,"maximum":26317,"setting":"inpatient","payers_information":[{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":26317,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":23532,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":25276.22,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":21873,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":25864,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":23857,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":10805.59,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":12606.53,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":12006.21,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":12246.34,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":12246.34,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12246.34,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":13017.26,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":12701.31,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":12638.11,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":13270.02,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":12954.07,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":12638.11,"methodology":"case rate"}]}]},{"description":"RESPIRATORY NEOPLASMS WITH CC","code_information":[{"code":"181","type":"MS-DRG"}],"standard_charges":[{"minimum":6971.19,"maximum":16718,"setting":"inpatient","payers_information":[{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":16718,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":14949,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":16306.86,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":13895,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16430,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":15156,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":6971.19,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":8133.05,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":7745.76,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":7900.68,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":7900.68,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":7900.68,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":8398.04,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":8194.2,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":8153.43,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":8561.11,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":8357.27,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":8153.43,"methodology":"case rate"}]}]},{"description":"RESPIRATORY NEOPLASMS WITHOUT CC/MCC","code_information":[{"code":"182","type":"MS-DRG"}],"standard_charges":[{"minimum":5330.37,"maximum":12610,"setting":"inpatient","payers_information":[{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":12610,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":11276,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":12468.68,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":10481,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12393,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":11432,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":5330.37,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":6218.77,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":5922.63,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":6041.09,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":6041.09,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6041.09,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6421.38,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":6265.52,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6234.34,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":6546.06,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6390.2,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":6234.34,"methodology":"case rate"}]}]},{"description":"MAJOR CHEST TRAUMA WITH MCC","code_information":[{"code":"183","type":"MS-DRG"}],"standard_charges":[{"minimum":9840.22,"maximum":23900,"setting":"inpatient","payers_information":[{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":23900,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":21371,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":23018.04,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":19864,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":23489,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":21667,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":9840.22,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":11480.25,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":10933.57,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":11152.25,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":11152.25,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11152.25,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":11854.3,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":11566.57,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":11509.02,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":12084.48,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":11796.75,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":11509.02,"methodology":"case rate"}]}]},{"description":"MAJOR CHEST TRAUMA WITH CC","code_information":[{"code":"184","type":"MS-DRG"}],"standard_charges":[{"minimum":6717.37,"maximum":16082,"setting":"inpatient","payers_information":[{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":16082,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":14381,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":15713.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":13367,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15806,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":14580,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":6717.37,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":7836.93,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":7463.74,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":7613.02,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":7613.02,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":7613.02,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":8092.26,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":7895.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7856.56,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":8249.39,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":8052.98,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":7856.56,"methodology":"case rate"}]}]},{"description":"MAJOR CHEST TRAUMA WITHOUT CC/MCC","code_information":[{"code":"185","type":"MS-DRG"}],"standard_charges":[{"minimum":4970.69,"maximum":11710,"setting":"inpatient","payers_information":[{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":11710,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":10471,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":11627.32,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":9733,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11508,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":10616,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":4970.69,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":5799.13,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":5522.98,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":5633.44,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":5633.44,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5633.44,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5988.07,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":5842.73,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5813.66,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":6104.35,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":5959.01,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":5813.66,"methodology":"case rate"}]}]},{"description":"PLEURAL EFFUSION WITH MCC","code_information":[{"code":"186","type":"MS-DRG"}],"standard_charges":[{"minimum":9796.32,"maximum":23790,"setting":"inpatient","payers_information":[{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":23790,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":21273,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":22915.34,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":19773,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":23381,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":21567,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":9796.32,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":11429.03,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":10884.79,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":11102.49,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":11102.49,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11102.49,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":11801.41,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":11514.96,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":11457.67,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":12030.56,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":11744.12,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":11457.67,"methodology":"case rate"}]}]},{"description":"PLEURAL EFFUSION WITH CC","code_information":[{"code":"187","type":"MS-DRG"}],"standard_charges":[{"minimum":6331.82,"maximum":15117,"setting":"inpatient","payers_information":[{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":15117,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":13518,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":14811.26,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":12565,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14857,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":13705,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":6331.82,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":7387.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":7035.35,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":7176.06,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":7176.06,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":7176.06,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":7627.8,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":7442.66,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7405.63,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":7775.92,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7590.78,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":7405.63,"methodology":"case rate"}]}]},{"description":"PLEURAL EFFUSION WITHOUT CC/MCC","code_information":[{"code":"188","type":"MS-DRG"}],"standard_charges":[{"minimum":4709.04,"maximum":11055,"setting":"inpatient","payers_information":[{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":11055,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":9885,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":11015.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":9188,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10865,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":10022,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":4709.04,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":5493.88,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":5232.26,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":5336.91,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":5336.91,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5336.91,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5672.87,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":5535.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5507.64,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":5783.03,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":5645.34,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":5507.64,"methodology":"case rate"}]}]},{"description":"PULMONARY EDEMA AND RESPIRATORY FAILURE","code_information":[{"code":"189","type":"MS-DRG"}],"standard_charges":[{"minimum":7735.67,"maximum":18632,"setting":"inpatient","payers_information":[{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":18632,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":16660,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":18095.1,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":15486,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":18311,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":16891,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":7735.67,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":9024.94,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":8595.18,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":8767.09,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":8767.09,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":8767.09,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":9318.98,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":9092.79,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":9047.55,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":9499.93,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":9273.74,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":9047.55,"methodology":"case rate"}]}]},{"description":"CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH MCC","code_information":[{"code":"190","type":"MS-DRG"}],"standard_charges":[{"minimum":7047.58,"maximum":16909,"setting":"inpatient","payers_information":[{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":16909,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":15120,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":16485.54,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":14054,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16618,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":15329,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":7047.58,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":8222.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":7830.64,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":7987.26,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":7987.26,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":7987.26,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":8490.06,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":8283.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":8242.77,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":8654.91,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":8448.84,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":8242.77,"methodology":"case rate"}]}]},{"description":"HC ASP OF BREAST CYST","code_information":[{"code":"19000","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":974.61,"maximum":974.61,"gross_charge":1071,"discounted_cash":504.53,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":974.61,"methodology":"fee schedule"}]}]},{"description":"HC ASP OF BREAST CYST","code_information":[{"code":"19000","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":251.58,"maximum":2152,"gross_charge":1071,"discounted_cash":504.53,"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":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2152,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":1821,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":1382.52,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":674.73,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":674.73,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":974.61,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":514.08,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":803.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":289.17,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":303.63,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":283.39,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":251.58,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":294.96,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":297.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":712,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":691.26,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":691.26,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":725.82,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":718.91,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":691.26,"methodology":"case rate"}]}]},{"description":"DRAIN BREAST LESION ADD-ON","code_information":[{"code":"19001","type":"CPT"}],"standard_charges":[{"minimum":1538.38,"maximum":1538.38,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"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|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC EXPLO/DRAIN BREAST ABSCESS","code_information":[{"code":"19020","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":2143.96,"maximum":2143.96,"gross_charge":2356,"discounted_cash":1109.88,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2143.96,"methodology":"fee schedule"}]}]},{"description":"HC EXPLO/DRAIN BREAST ABSCESS","code_information":[{"code":"19020","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":553.43,"maximum":3183.7,"gross_charge":2356,"discounted_cash":1109.88,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1484.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1484.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1484.28,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2376,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":2011,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":3183.7,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1484.28,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":1484.28,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1923.63,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2143.96,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1130.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":1767,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":636.12,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":667.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":623.4,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":553.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":648.85,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":655.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1639.61,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":1591.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1591.85,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":1671.44,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1655.52,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":1591.85,"methodology":"case rate"}]}]},{"description":"INJECTION FOR BREAST X-RAY","code_information":[{"code":"19030","type":"CPT"}],"standard_charges":[{"minimum":1538.38,"maximum":1538.38,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"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|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"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 STRTCTC","code_information":[{"code":"19081","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":4954.04,"maximum":4954.04,"gross_charge":5444,"discounted_cash":2564.58,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4954.04,"methodology":"fee schedule"}]}]},{"description":"HC BX BREAST 1ST LESION STRTCTC","code_information":[{"code":"19081","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":1278.8,"maximum":4954.04,"gross_charge":5444,"discounted_cash":2564.58,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3429.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3429.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3429.72,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2376,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":2011,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":3183.7,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3429.72,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3429.72,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4954.04,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2613.12,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":4083,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":1469.88,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":1543.38,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":1440.49,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":1278.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1499.28,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1513.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1639.61,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":1591.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1591.85,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":1671.44,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1655.52,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":1591.85,"methodology":"case rate"}]}]},{"description":"BX BREAST ADD LESION STRTCTC","code_information":[{"code":"19082","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"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|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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":52,"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":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"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 US IMAG","code_information":[{"code":"19083","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":1605.24,"maximum":1605.24,"gross_charge":1764,"discounted_cash":831,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1605.24,"methodology":"fee schedule"}]}]},{"description":"HC BX BREAST 1ST LESION US IMAG","code_information":[{"code":"19083","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":414.37,"maximum":3183.7,"gross_charge":1764,"discounted_cash":831,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1111.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1111.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1111.32,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2376,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":2011,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":3183.7,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1111.32,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":1111.32,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1605.24,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":846.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":1323,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":476.28,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":500.1,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":466.76,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":414.37,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":485.81,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":490.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1639.61,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":1591.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1591.85,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":1671.44,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1655.52,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":1591.85,"methodology":"case rate"}]}]},{"description":"BX BREAST ADD LESION US IMAG","code_information":[{"code":"19084","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"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|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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":52,"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":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"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":978.25,"maximum":978.25,"gross_charge":1075,"discounted_cash":506.42,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":978.25,"methodology":"fee schedule"}]}]},{"description":"HC BX BREAST 1ST LESION MR IMAG","code_information":[{"code":"19085","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":252.52,"maximum":3183.7,"gross_charge":1075,"discounted_cash":506.42,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":677.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":677.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":677.25,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2376,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":2011,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":3183.7,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":677.25,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":677.25,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":978.25,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":516,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":806.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":290.25,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":304.77,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":284.45,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":252.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":296.06,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":298.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1639.61,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":1591.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1591.85,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":1671.44,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1655.52,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":1591.85,"methodology":"case rate"}]}]},{"description":"HC BX BREAST ADD LESION MR IMAG","code_information":[{"code":"19086","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":978.25,"maximum":978.25,"gross_charge":1075,"discounted_cash":506.42,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":978.25,"methodology":"fee schedule"}]}]},{"description":"HC BX BREAST ADD LESION MR IMAG","code_information":[{"code":"19086","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":252.52,"maximum":978.25,"gross_charge":1075,"discounted_cash":506.42,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":677.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":677.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":677.25,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":677.25,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":677.25,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":559,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":978.25,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":516,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":806.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":290.25,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":304.77,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":284.45,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":252.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":296.06,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":298.96,"methodology":"fee schedule"}]}]},{"description":"CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH CC","code_information":[{"code":"191","type":"MS-DRG"}],"standard_charges":[{"minimum":5460.29,"maximum":12935,"setting":"inpatient","payers_information":[{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":12935,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":11567,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":12772.58,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":10751,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12713,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":11727,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":5460.29,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":6370.33,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":6066.98,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":6188.32,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":6188.32,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6188.32,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6577.88,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":6418.23,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.29,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":6705.61,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6545.95,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.29,"methodology":"case rate"}]}]},{"description":"BX BREAST PERCUT W/O IMAGE","code_information":[{"code":"19100","type":"CPT"}],"standard_charges":[{"minimum":1538.38,"maximum":3183.7,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2152,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":1821,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":3183.7,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1639.61,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":1591.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1591.85,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":1671.44,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1655.52,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":1591.85,"methodology":"case rate"}]}]},{"description":"BIOPSY OF BREAST OPEN","code_information":[{"code":"19101","type":"CPT"}],"standard_charges":[{"minimum":1923.63,"maximum":7524.38,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2376,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":2011,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":7524.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1923.63,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3875.06,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":3762.19,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3762.19,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":3950.3,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3912.68,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":3762.19,"methodology":"case rate"}]}]},{"description":"CRYOSURG ABLATE FA EACH","code_information":[{"code":"19105","type":"CPT"}],"standard_charges":[{"minimum":3762.19,"maximum":7524.38,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":7524.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":3917.28,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3875.06,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":3762.19,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3762.19,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":3950.3,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3912.68,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":3762.19,"methodology":"case rate"}]}]},{"description":"NIPPLE EXPLORATION","code_information":[{"code":"19110","type":"CPT"}],"standard_charges":[{"minimum":1923.63,"maximum":7524.38,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2376,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":2011,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":7524.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1923.63,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3875.06,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":3762.19,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3762.19,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":3950.3,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3912.68,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":3762.19,"methodology":"case rate"}]}]},{"description":"EXCISE BREAST DUCT FISTULA","code_information":[{"code":"19112","type":"CPT"}],"standard_charges":[{"minimum":2657.78,"maximum":7524.38,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":3796,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3212,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":7524.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":2657.78,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3875.06,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":3762.19,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3762.19,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":3950.3,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3912.68,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":3762.19,"methodology":"case rate"}]}]},{"description":"REMOVAL OF BREAST LESION","code_information":[{"code":"19120","type":"CPT"}],"standard_charges":[{"minimum":2657.78,"maximum":7524.38,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":3796,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3212,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":7524.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":2657.78,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3875.06,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":3762.19,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3762.19,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":3950.3,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3912.68,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":3762.19,"methodology":"case rate"}]}]},{"description":"EXCISION BREAST LESION","code_information":[{"code":"19125","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":7632.17,"maximum":7632.17,"gross_charge":8387,"discounted_cash":3950.98,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":7632.17,"methodology":"fee schedule"}]}]},{"description":"EXCISION BREAST LESION","code_information":[{"code":"19125","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":1970.11,"maximum":7632.17,"gross_charge":8387,"discounted_cash":3950.98,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5283.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5283.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5283.81,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":3796,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3212,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":7524.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5283.81,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":5283.81,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2657.78,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":7632.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4025.76,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":6290.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":2264.49,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":2377.72,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":2219.21,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":1970.11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2309.78,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2332.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3875.06,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":3762.19,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3762.19,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":3950.3,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3912.68,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":3762.19,"methodology":"case rate"}]}]},{"description":"EXCISION ADDL BREAST LESION","code_information":[{"code":"19126","type":"CPT"}],"standard_charges":[{"minimum":2657.78,"maximum":3796,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":3796,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3212,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":2657.78,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITHOUT CC/MCC","code_information":[{"code":"192","type":"MS-DRG"}],"standard_charges":[{"minimum":4185.76,"maximum":9791.24,"setting":"inpatient","payers_information":[{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":9745,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":8714,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":9791.24,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":8099,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9577,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":8834,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":4185.76,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":4883.39,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":4650.84,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":4743.86,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":4743.86,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4743.86,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5042.49,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":4920.1,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":4895.62,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":5140.41,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":5018.02,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":4895.62,"methodology":"case rate"}]}]},{"description":"HC PERQ DEVICE BREAST 1ST IMAG","code_information":[{"code":"19281","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":554.19,"maximum":554.19,"gross_charge":609,"discounted_cash":286.89,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":554.19,"methodology":"fee schedule"}]}]},{"description":"HC PERQ DEVICE BREAST 1ST IMAG","code_information":[{"code":"19281","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":143.06,"maximum":3183.7,"gross_charge":609,"discounted_cash":286.89,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":383.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":383.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":383.67,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2152,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":1821,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":3183.7,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":383.67,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":383.67,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":554.19,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":292.32,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":456.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":164.43,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":172.66,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":161.15,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":143.06,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":167.72,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":169.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1639.61,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":1591.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1591.85,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":1671.44,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1655.52,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":1591.85,"methodology":"case rate"}]}]},{"description":"HC PERQ DEVICE BREAST EA IMAG","code_information":[{"code":"19282","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":260.26,"maximum":260.26,"gross_charge":286,"discounted_cash":134.73,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":260.26,"methodology":"fee schedule"}]}]},{"description":"HC PERQ DEVICE BREAST EA IMAG","code_information":[{"code":"19282","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":67.19,"maximum":260.26,"gross_charge":286,"discounted_cash":134.73,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":180.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":180.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":180.18,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":180.18,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":180.18,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":148.72,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":260.26,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":137.28,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":214.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":77.22,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":81.09,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":75.68,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":67.19,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":78.77,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":79.54,"methodology":"fee schedule"}]}]},{"description":"HC PERQ DEV BREAST 1ST STRTCTC","code_information":[{"code":"19283","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":559.65,"maximum":559.65,"gross_charge":615,"discounted_cash":289.72,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":559.65,"methodology":"fee schedule"}]}]},{"description":"HC PERQ DEV BREAST 1ST STRTCTC","code_information":[{"code":"19283","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":144.47,"maximum":2152,"gross_charge":615,"discounted_cash":289.72,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":387.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":387.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":387.45,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2152,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":1821,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":1382.52,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":387.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":387.45,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":559.65,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":295.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":461.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":166.05,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":174.36,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":162.73,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":144.47,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":169.38,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":171.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":712,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":691.26,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":691.26,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":725.82,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":718.91,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":691.26,"methodology":"case rate"}]}]},{"description":"HC PERQ DEV BREAST ADD STRTCTC","code_information":[{"code":"19284","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":544.18,"maximum":544.18,"gross_charge":598,"discounted_cash":281.71,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":544.18,"methodology":"fee schedule"}]}]},{"description":"HC PERQ DEV BREAST ADD STRTCTC","code_information":[{"code":"19284","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":140.48,"maximum":544.18,"gross_charge":598,"discounted_cash":281.71,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":376.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":376.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":376.74,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":376.74,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":376.74,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":310.96,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":544.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":287.04,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":448.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":161.46,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":169.54,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":158.24,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":140.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":164.69,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":166.31,"methodology":"fee schedule"}]}]},{"description":"HC PERQ DEV BREAST 1ST US IMAG","code_information":[{"code":"19285","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":828.1,"maximum":828.1,"gross_charge":910,"discounted_cash":428.69,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":828.1,"methodology":"fee schedule"}]}]},{"description":"HC PERQ DEV BREAST 1ST US IMAG","code_information":[{"code":"19285","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":213.76,"maximum":2152,"gross_charge":910,"discounted_cash":428.69,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":573.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":573.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":573.3,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2152,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":1821,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":1382.52,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":573.3,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":573.3,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":828.1,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":436.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":682.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":245.7,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":257.99,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":240.79,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":213.76,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":250.62,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":253.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":712,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":691.26,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":691.26,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":725.82,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":718.91,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":691.26,"methodology":"case rate"}]}]},{"description":"HC PERQ DEV BREAST ADD US IMAG","code_information":[{"code":"19286","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":505.05,"maximum":505.05,"gross_charge":555,"discounted_cash":261.46,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":505.05,"methodology":"fee schedule"}]}]},{"description":"HC PERQ DEV BREAST ADD US IMAG","code_information":[{"code":"19286","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":130.37,"maximum":505.05,"gross_charge":555,"discounted_cash":261.46,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":349.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":349.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":349.65,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":349.65,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":349.65,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":288.6,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":505.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":266.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":416.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":149.85,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":157.35,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":146.86,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":130.37,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":152.85,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":154.35,"methodology":"fee schedule"}]}]},{"description":"PERQ DEV BREAST 1ST MR GUIDE","code_information":[{"code":"19287","type":"CPT"}],"standard_charges":[{"minimum":691.26,"maximum":2152,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2152,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":1821,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":1382.52,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":712,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":691.26,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":691.26,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":725.82,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":718.91,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":691.26,"methodology":"case rate"}]}]},{"description":"PERQ DEV BREAST ADD MR GUIDE","code_information":[{"code":"19288","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"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|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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":52,"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":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"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":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"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|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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":52,"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":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"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":4901,"maximum":18802.8,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":5792,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":4901,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":18802.8,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":5385.62,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":9683.44,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":9401.4,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":9401.4,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":9871.47,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":9777.46,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":9401.4,"methodology":"case rate"}]}]},{"description":"PLACE BREAST CATH FOR RAD","code_information":[{"code":"19297","type":"CPT"}],"standard_charges":[{"minimum":4901,"maximum":5792,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":5792,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":4901,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":5385.62,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"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":4901,"maximum":12814.4,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":5792,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":4901,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":12814.4,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":5385.62,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6599.42,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":6407.2,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6407.2,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":6727.56,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6663.49,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":6407.2,"methodology":"case rate"}]}]},{"description":"SIMPLE PNEUMONIA AND PLEURISY WITH MCC","code_information":[{"code":"193","type":"MS-DRG"}],"standard_charges":[{"minimum":8218.64,"maximum":19841,"setting":"inpatient","payers_information":[{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":19841,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":17742,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":19224.88,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":16490,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":19499,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":17987,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":8218.64,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":9588.42,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":9131.82,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":9314.46,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":9314.46,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":9314.46,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":9900.82,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":9660.51,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":9612.44,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":10093.07,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":9852.76,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":9612.44,"methodology":"case rate"}]}]},{"description":"REMOVAL OF BREAST TISSUE","code_information":[{"code":"19300","type":"CPT"}],"standard_charges":[{"minimum":3517,"maximum":12323,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":4157,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3517,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":7524.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":12323,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3875.06,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":3762.19,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3762.19,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":3950.3,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3912.68,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":3762.19,"methodology":"case rate"}]}]},{"description":"PARTIAL MASTECTOMY","code_information":[{"code":"19301","type":"CPT"}],"standard_charges":[{"minimum":3212,"maximum":12323,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":3796,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3212,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":7524.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":12323,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3875.06,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":3762.19,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3762.19,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":3950.3,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3912.68,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":3762.19,"methodology":"case rate"}]}]},{"description":"P-MASTECTOMY W/LN REMOVAL","code_information":[{"code":"19302","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":13056.68,"maximum":13056.68,"gross_charge":14348,"discounted_cash":6759.1,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":13056.68,"methodology":"fee schedule"}]}]},{"description":"P-MASTECTOMY W/LN REMOVAL","code_information":[{"code":"19302","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":3370.35,"maximum":13056.68,"gross_charge":14348,"discounted_cash":6759.1,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9039.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":9039.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9039.24,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":5489,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":4645,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":12814.4,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9039.24,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":9039.24,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":12323,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":13056.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6887.04,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":10761,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":3873.96,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":4067.66,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":3796.49,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":3370.35,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3951.44,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3990.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6599.42,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":6407.2,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6407.2,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":6727.56,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6663.49,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":6407.2,"methodology":"case rate"}]}]},{"description":"MAST SIMPLE COMPLETE","code_information":[{"code":"19303","type":"CPT"}],"standard_charges":[{"minimum":3517,"maximum":12814.4,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":4157,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3517,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":12814.4,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":12323,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_percentage":48,"median_amount":3293.37,"10th_percentile":3293.37,"90th_percentile":3293.37,"count":"1 through 10","methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6599.42,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":6407.2,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6407.2,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":6727.56,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6663.49,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":6407.2,"methodology":"case rate"}]}]},{"description":"MAST RADICAL","code_information":[{"code":"19305","type":"CPT"}],"standard_charges":[{"minimum":12323,"maximum":12323,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"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|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":12323,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"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":12323,"maximum":12323,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"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|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":12323,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"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":4901,"maximum":12814.4,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":5792,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":4901,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":12814.4,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":12323,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_percentage":48,"median_amount":6685.37,"10th_percentile":6685.37,"90th_percentile":6685.37,"count":"1 through 10","methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6599.42,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":6407.2,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6407.2,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":6727.56,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6663.49,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":6407.2,"methodology":"case rate"}]}]},{"description":"SUSPENSION OF BREAST","code_information":[{"code":"19316","type":"CPT"}],"standard_charges":[{"minimum":3078.06,"maximum":12814.4,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":4157,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3517,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":12814.4,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":3078.06,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6599.42,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":6407.2,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6407.2,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":6727.56,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6663.49,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":6407.2,"methodology":"case rate"}]}]},{"description":"BREAST REDUCTION","code_information":[{"code":"19318","type":"CPT"}],"standard_charges":[{"minimum":3078.06,"maximum":12814.4,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":4157,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3517,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":12814.4,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":3078.06,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_percentage":48,"median_amount":18216.43,"10th_percentile":18216.43,"90th_percentile":18216.43,"count":"1 through 10","methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6599.42,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":6407.2,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6407.2,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":6727.56,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6663.49,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":6407.2,"methodology":"case rate"}]}]},{"description":"ENLARGE BREAST","code_information":[{"code":"19324","type":"CPT"}],"standard_charges":[{"minimum":3517,"maximum":4157,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":4157,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3517,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"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":4901,"maximum":18802.8,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"median_amount":2729.26,"10th_percentile":2729.26,"90th_percentile":2729.26,"count":"1 through 10","methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"median_amount":2729.26,"10th_percentile":2729.26,"90th_percentile":2729.26,"count":"1 through 10","methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"median_amount":2729.26,"10th_percentile":2729.26,"90th_percentile":2729.26,"count":"1 through 10","methodology":"percent of total billed charges"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":5792,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":4901,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":18802.8,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":5385.62,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":9683.44,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":9401.4,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":9401.4,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":9871.47,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":9777.46,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":9401.4,"methodology":"case rate"}]}]},{"description":"HC REMOVAL INTACT BREAST IMPLANT","code_information":[{"code":"19328","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":4650.1,"maximum":4650.1,"gross_charge":5110,"discounted_cash":2407.24,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4650.1,"methodology":"fee schedule"}]}]},{"description":"HC REMOVAL INTACT BREAST IMPLANT","code_information":[{"code":"19328","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":1200.34,"maximum":7524.38,"gross_charge":5110,"discounted_cash":2407.24,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3219.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3219.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3219.3,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2152,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":1821,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":7524.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3219.3,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3219.3,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4650.1,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2452.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":3832.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":1379.7,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":1448.69,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":1352.11,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":1200.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1407.3,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1421.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3875.06,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":3762.19,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3762.19,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":3950.3,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3912.68,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":3762.19,"methodology":"case rate"}]}]},{"description":"REMOVAL OF IMPLANT MATERIAL","code_information":[{"code":"19330","type":"CPT"}],"standard_charges":[{"minimum":1538.38,"maximum":7524.38,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2152,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":1821,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":7524.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3875.06,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":3762.19,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3762.19,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":3950.3,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3912.68,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":3762.19,"methodology":"case rate"}]}]},{"description":"IMMEDIATE BREAST PROSTHESIS","code_information":[{"code":"19340","type":"CPT"}],"standard_charges":[{"minimum":1923.63,"maximum":12814.4,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2376,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":2011,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":12814.4,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1923.63,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6599.42,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":6407.2,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6407.2,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":6727.56,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6663.49,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":6407.2,"methodology":"case rate"}]}]},{"description":"DELAYED BREAST PROSTHESIS","code_information":[{"code":"19342","type":"CPT"}],"standard_charges":[{"minimum":2657.78,"maximum":18802.8,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":3796,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3212,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":18802.8,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":2657.78,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_percentage":48,"median_amount":18037.27,"10th_percentile":18037.27,"90th_percentile":18037.27,"count":"1 through 10","methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":9683.44,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":9401.4,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":9401.4,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":9871.47,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":9777.46,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":9401.4,"methodology":"case rate"}]}]},{"description":"BREAST RECONSTRUCTION","code_information":[{"code":"19350","type":"CPT"}],"standard_charges":[{"minimum":3078.06,"maximum":7524.38,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":4157,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3517,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":7524.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":3078.06,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3875.06,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":3762.19,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3762.19,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":3950.3,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3912.68,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":3762.19,"methodology":"case rate"}]}]},{"description":"CORRECT INVERTED NIPPLE(S)","code_information":[{"code":"19355","type":"CPT"}],"standard_charges":[{"minimum":3078.06,"maximum":7524.38,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":4157,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3517,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":7524.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":3078.06,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3875.06,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":3762.19,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3762.19,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":3950.3,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3912.68,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":3762.19,"methodology":"case rate"}]}]},{"description":"BREAST RECONSTRUCTION","code_information":[{"code":"19357","type":"CPT"}],"standard_charges":[{"minimum":3497.02,"maximum":34187.06,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":4514,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3819,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":34187.06,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":3497.02,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_percentage":48,"median_amount":3293.37,"10th_percentile":3293.37,"90th_percentile":3293.37,"count":"1 through 10","methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"median_amount":7168.62,"10th_percentile":7168.62,"90th_percentile":7168.62,"count":"1 through 10","methodology":"percent of total billed charges"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":17606.34,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":17093.53,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":17093.53,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":17948.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":17777.27,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":17093.53,"methodology":"case rate"}]}]},{"description":"BREAST RECONSTR W/LAT FLAP","code_information":[{"code":"19361","type":"CPT"}],"standard_charges":[{"minimum":1923.63,"maximum":1923.63,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"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|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1923.63,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"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":3517,"maximum":4157,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":4157,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3517,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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":52,"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":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"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":3819,"maximum":4514,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":4514,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3819,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"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":3078.06,"maximum":3078.06,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"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|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":3078.06,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"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":3497.02,"maximum":3497.02,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"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|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":3497.02,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"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":3497.02,"maximum":3497.02,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"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|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":3497.02,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"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":3078.06,"maximum":7524.38,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"median_amount":15.91,"10th_percentile":1.73,"90th_percentile":2729.26,"count":"1 through 10","methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"median_amount":15.91,"10th_percentile":1.73,"90th_percentile":2729.26,"count":"1 through 10","methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"median_amount":15.91,"10th_percentile":1.73,"90th_percentile":2729.26,"count":"1 through 10","methodology":"percent of total billed charges"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":4157,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3517,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":7524.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":3078.06,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"median_amount":7168.62,"10th_percentile":5660.14,"90th_percentile":7168.62,"count":"1 through 10","methodology":"percent of total billed charges"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3875.06,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":3762.19,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3762.19,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":3950.3,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3912.68,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":3762.19,"methodology":"case rate"}]}]},{"description":"PERI-IMPLT CAPSLC BRST COMPL","code_information":[{"code":"19371","type":"CPT"}],"standard_charges":[{"minimum":3078.06,"maximum":7524.38,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":4157,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3517,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":7524.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":3078.06,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3875.06,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":3762.19,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3762.19,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":3950.3,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3912.68,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":3762.19,"methodology":"case rate"}]}]},{"description":"REVISE BREAST RECONSTRUCTION","code_information":[{"code":"19380","type":"CPT"}],"standard_charges":[{"minimum":3497.02,"maximum":12814.4,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":4514,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3819,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":12814.4,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"median_amount":3243.2,"10th_percentile":3243.2,"90th_percentile":3243.2,"count":"1 through 10","methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"median_amount":3243.2,"10th_percentile":3243.2,"90th_percentile":3243.2,"count":"1 through 10","methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3497.02,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"median_amount":1691.13,"10th_percentile":1691.13,"90th_percentile":1691.13,"count":"1 through 10","methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6599.42,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":6407.2,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6407.2,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":6727.56,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6663.49,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":6407.2,"methodology":"case rate"}]}]},{"description":"DESIGN CUSTOM BREAST IMPLANT","code_information":[{"code":"19396","type":"CPT"}],"standard_charges":[{"minimum":3078.06,"maximum":7524.38,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":7524.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":3078.06,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3875.06,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":3762.19,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3762.19,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":3950.3,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3912.68,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":3762.19,"methodology":"case rate"}]}]},{"description":"SIMPLE PNEUMONIA AND PLEURISY WITH CC","code_information":[{"code":"194","type":"MS-DRG"}],"standard_charges":[{"minimum":5225.11,"maximum":12347,"setting":"inpatient","payers_information":[{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":12347,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":11040,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":12222.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":10262,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12134,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":11193,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":5225.11,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":6095.96,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":5805.67,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":5921.79,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":5921.79,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5921.79,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6294.57,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":6141.79,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6111.23,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":6416.8,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6264.02,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":6111.23,"methodology":"case rate"}]}]},{"description":"UNLISTED PROCEDURE BREAST","code_information":[{"code":"19499","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":13056.68,"maximum":13056.68,"gross_charge":14348,"discounted_cash":6759.1,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":13056.68,"methodology":"fee schedule"}]}]},{"description":"UNLISTED PROCEDURE BREAST","code_information":[{"code":"19499","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":1538.38,"maximum":13056.68,"gross_charge":14348,"discounted_cash":6759.1,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9039.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":9039.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9039.24,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":7524.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9039.24,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":9039.24,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":13056.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6887.04,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":10761,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":3873.96,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":4067.66,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":3796.49,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":3370.35,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3951.44,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3990.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3875.06,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":3762.19,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3762.19,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":3950.3,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3912.68,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":3762.19,"methodology":"case rate"}]}]},{"description":"SIMPLE PNEUMONIA AND PLEURISY WITHOUT CC/MCC","code_information":[{"code":"195","type":"MS-DRG"}],"standard_charges":[{"minimum":4038.4,"maximum":9446.54,"setting":"inpatient","payers_information":[{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":9376,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":8384,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":9446.54,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":7793,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9215,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":8500,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":4038.4,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":4711.47,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":4487.11,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":4576.86,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":4576.86,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4576.86,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":4864.97,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":4746.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":4723.27,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":4959.44,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":4841.36,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":4723.27,"methodology":"case rate"}]}]},{"description":"INTERSTITIAL LUNG DISEASE WITH MCC","code_information":[{"code":"196","type":"MS-DRG"}],"standard_charges":[{"minimum":11625.4,"maximum":28369,"setting":"inpatient","payers_information":[{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":28369,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":25368,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":27193.9,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":23579,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":27881,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":25718,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":11625.4,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":13562.97,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":12917.11,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":13175.46,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":13175.46,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13175.46,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":14004.86,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":13664.94,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":13596.95,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":14276.8,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":13936.88,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":13596.95,"methodology":"case rate"}]}]},{"description":"INTERSTITIAL LUNG DISEASE WITH CC","code_information":[{"code":"197","type":"MS-DRG"}],"standard_charges":[{"minimum":6247.62,"maximum":14906,"setting":"inpatient","payers_information":[{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":14906,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":13329,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":14614.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":12389,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14650,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":13514,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":6247.62,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":7288.88,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":6941.79,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":7080.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":7080.63,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":7080.63,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":7526.36,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":7343.68,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7307.14,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":7672.5,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7489.82,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":7307.14,"methodology":"case rate"}]}]},{"description":"INTERSTITIAL LUNG DISEASE WITHOUT CC/MCC","code_information":[{"code":"198","type":"MS-DRG"}],"standard_charges":[{"minimum":4505.75,"maximum":10546,"setting":"inpatient","payers_information":[{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":10546,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":9430,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":10539.74,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":8765,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10365,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":9560,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":4505.75,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":5256.7,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":5006.38,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":5106.51,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":5106.51,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5106.51,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5427.97,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":5296.22,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5269.87,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":5533.37,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":5401.62,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":5269.87,"methodology":"case rate"}]}]},{"description":"PNEUMOTHORAX WITH MCC","code_information":[{"code":"199","type":"MS-DRG"}],"standard_charges":[{"minimum":10910.85,"maximum":26580,"setting":"inpatient","payers_information":[{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":26580,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":23768,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":25522.44,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":22092,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":26123,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":24096,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":10910.85,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":12729.32,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":12123.16,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":12365.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":12365.63,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12365.63,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":13144.06,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":12825.03,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":12761.22,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":13399.29,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":13080.26,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":12761.22,"methodology":"case rate"}]}]},{"description":"PNEUMOTHORAX WITH CC","code_information":[{"code":"200","type":"MS-DRG"}],"standard_charges":[{"minimum":6954.35,"maximum":16676,"setting":"inpatient","payers_information":[{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":16676,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":14911,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":16267.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":13860,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16389,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":15117,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":6954.35,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":8113.41,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":7727.05,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":7881.6,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":7881.6,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":7881.6,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":8377.75,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":8174.4,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":8133.73,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":8540.42,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":8337.08,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":8133.73,"methodology":"case rate"}]}]},{"description":"PNEUMOTHORAX WITHOUT CC/MCC","code_information":[{"code":"201","type":"MS-DRG"}],"standard_charges":[{"minimum":4365.61,"maximum":10211.92,"setting":"inpatient","payers_information":[{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":10195,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":9116,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":10211.92,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":8474,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10020,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":9242,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":4365.61,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":5093.21,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":4850.67,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":4947.69,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":4947.69,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4947.69,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5259.14,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":5131.49,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5105.96,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":5361.26,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":5233.61,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":5105.96,"methodology":"case rate"}]}]},{"description":"HC EXPLORE WOUNDNECK","code_information":[{"code":"20100","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":521.43,"maximum":521.43,"gross_charge":573,"discounted_cash":269.94,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":521.43,"methodology":"fee schedule"}]}]},{"description":"HC EXPLORE WOUNDNECK","code_information":[{"code":"20100","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":134.6,"maximum":1538.38,"gross_charge":573,"discounted_cash":269.94,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":360.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":360.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":360.99,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":303.69,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":269.31,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":1000.66,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":360.99,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":360.99,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":521.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":275.04,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":429.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":154.71,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":162.45,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":151.62,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":134.6,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":157.81,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":159.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":515.34,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":500.33,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":500.33,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":525.35,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":520.34,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":500.33,"methodology":"case rate"}]}]},{"description":"HC EXPLORATION WOUND CHEST","code_information":[{"code":"20101","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":2647.19,"maximum":2647.19,"gross_charge":2909,"discounted_cash":1370.39,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2647.19,"methodology":"fee schedule"}]}]},{"description":"HC EXPLORATION WOUND CHEST","code_information":[{"code":"20101","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":683.33,"maximum":3594.36,"gross_charge":2909,"discounted_cash":1370.39,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1832.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1832.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1832.67,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":1541.77,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":1367.23,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":3594.36,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1832.67,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":1832.67,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2647.19,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1396.32,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":2181.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":785.43,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":824.71,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":769.73,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":683.33,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":801.14,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":809,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1851.1,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":1797.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1797.18,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":1887.04,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1869.07,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":1797.18,"methodology":"case rate"}]}]},{"description":"HC EXPLORATION WOUND TRUNK","code_information":[{"code":"20102","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":2647.19,"maximum":2647.19,"gross_charge":2909,"discounted_cash":1370.39,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2647.19,"methodology":"fee schedule"}]}]},{"description":"HC EXPLORATION WOUND TRUNK","code_information":[{"code":"20102","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":683.33,"maximum":3594.36,"gross_charge":2909,"discounted_cash":1370.39,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1832.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1832.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1832.67,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":1541.77,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":1367.23,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":3594.36,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1832.67,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":1832.67,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2647.19,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1396.32,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":2181.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":785.43,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":824.71,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":769.73,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":683.33,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":801.14,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":809,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1851.1,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":1797.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1797.18,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":1887.04,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1869.07,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":1797.18,"methodology":"case rate"}]}]},{"description":"HC EXPLORATION WOUND EXTREMITY","code_information":[{"code":"20103","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":819,"maximum":819,"gross_charge":900,"discounted_cash":423.98,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":819,"methodology":"fee schedule"}]}]},{"description":"HC EXPLORATION WOUND EXTREMITY","code_information":[{"code":"20103","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":211.41,"maximum":3183.7,"gross_charge":900,"discounted_cash":423.98,"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 - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2376,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":2011,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":3183.7,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":567,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":567,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":819,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":432,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":675,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":243,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":255.15,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":238.14,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":211.41,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":247.86,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":250.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1639.61,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":1591.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1591.85,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":1671.44,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1655.52,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":1591.85,"methodology":"case rate"}]}]},{"description":"EXCISE EPIPHYSEAL BAR","code_information":[{"code":"20150","type":"CPT"}],"standard_charges":[{"minimum":3187.76,"maximum":6375.52,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":6375.52,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":4266.22,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3283.39,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":3187.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3187.76,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":3347.15,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3315.27,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":3187.76,"methodology":"case rate"}]}]},{"description":"BRONCHITIS AND ASTHMA WITH CC/MCC","code_information":[{"code":"202","type":"MS-DRG"}],"standard_charges":[{"minimum":6107.47,"maximum":14556,"setting":"inpatient","payers_information":[{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":14556,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":13016,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":14286.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":12098,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14305,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":13195,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":6107.47,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":7125.38,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":6786.07,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":6921.8,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":6921.8,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6921.8,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":7357.53,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":7178.95,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7143.23,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":7500.4,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7321.82,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":7143.23,"methodology":"case rate"}]}]},{"description":"MUSCLE BIOPSY","code_information":[{"code":"20200","type":"CPT"}],"standard_charges":[{"minimum":1591.85,"maximum":3183.7,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2376,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":2011,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":3183.7,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1923.63,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1639.61,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":1591.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1591.85,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":1671.44,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1655.52,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":1591.85,"methodology":"case rate"}]}]},{"description":"DEEP MUSCLE BIOPSY","code_information":[{"code":"20205","type":"CPT"}],"standard_charges":[{"minimum":2657.78,"maximum":5623.82,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"median_amount":3811.5,"10th_percentile":3811.5,"90th_percentile":3811.5,"count":"1 through 10","methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"median_amount":3811.5,"10th_percentile":3811.5,"90th_percentile":3811.5,"count":"1 through 10","methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"median_amount":3811.5,"10th_percentile":3811.5,"90th_percentile":3811.5,"count":"1 through 10","methodology":"percent of total billed charges"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":3796,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3212,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":5623.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":2657.78,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2896.27,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":2811.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2811.91,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":2952.51,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2924.39,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":2811.91,"methodology":"case rate"}]}]},{"description":"HC BIOPSY MUSCLE NEEDLE","code_information":[{"code":"20206","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":1696.24,"maximum":1696.24,"gross_charge":1864,"discounted_cash":878.1,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1696.24,"methodology":"fee schedule"}]}]},{"description":"HC BIOPSY MUSCLE NEEDLE","code_information":[{"code":"20206","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":437.86,"maximum":3183.7,"gross_charge":1864,"discounted_cash":878.1,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1174.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1174.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1174.32,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2152,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":1821,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":3183.7,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1174.32,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":1174.32,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1696.24,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":894.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":1398,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":503.28,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":528.45,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":493.22,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":437.86,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":513.35,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":518.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1639.61,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":1591.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1591.85,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":1671.44,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1655.52,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":1591.85,"methodology":"case rate"}]}]},{"description":"HC BIOPSY BONE TROCR NDLE","code_information":[{"code":"20220","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":1900.08,"maximum":1900.08,"gross_charge":2088,"discounted_cash":983.63,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1900.08,"methodology":"fee schedule"}]}]},{"description":"HC BIOPSY BONE TROCR NDLE","code_information":[{"code":"20220","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":490.48,"maximum":3183.7,"gross_charge":2088,"discounted_cash":983.63,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1315.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1315.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1315.44,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2152,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":1821,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":3183.7,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1315.44,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":1315.44,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1900.08,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1002.24,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":1566,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":563.76,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":591.95,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":552.49,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":490.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":575.04,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":580.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1639.61,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":1591.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1591.85,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":1671.44,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1655.52,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":1591.85,"methodology":"case rate"}]}]},{"description":"BONE BIOPSY TROCAR/NEEDLE","code_information":[{"code":"20225","type":"CPT"}],"standard_charges":[{"minimum":1591.85,"maximum":3183.7,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"median_amount":2203.74,"10th_percentile":2203.74,"90th_percentile":2203.74,"count":"1 through 10","methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"median_amount":2203.74,"10th_percentile":2203.74,"90th_percentile":2203.74,"count":"1 through 10","methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"median_amount":2203.74,"10th_percentile":2203.74,"90th_percentile":2203.74,"count":"1 through 10","methodology":"percent of total billed charges"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2376,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":2011,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":3183.7,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1923.63,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1639.61,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":1591.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1591.85,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":1671.44,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1655.52,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":1591.85,"methodology":"case rate"}]}]},{"description":"BONE BIOPSY OPEN SUPERFICIAL","code_information":[{"code":"20240","type":"CPT"}],"standard_charges":[{"minimum":1923.63,"maximum":5623.82,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2376,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":2011,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":5623.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1923.63,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2896.27,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":2811.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2811.91,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":2952.51,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2924.39,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":2811.91,"methodology":"case rate"}]}]},{"description":"BONE BIOPSY OPEN DEEP","code_information":[{"code":"20245","type":"CPT"}],"standard_charges":[{"minimum":2657.78,"maximum":5623.82,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":3796,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3212,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":5623.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":2657.78,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"median_amount":1358.3,"10th_percentile":1358.3,"90th_percentile":1358.3,"count":"1 through 10","methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2896.27,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":2811.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2811.91,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":2952.51,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2924.39,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":2811.91,"methodology":"case rate"}]}]},{"description":"OPEN BONE BIOPSY","code_information":[{"code":"20250","type":"CPT"}],"standard_charges":[{"minimum":2657.78,"maximum":6375.52,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":3796,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3212,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":6375.52,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":2657.78,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3283.39,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":3187.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3187.76,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":3347.15,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3315.27,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":3187.76,"methodology":"case rate"}]}]},{"description":"OPEN BONE BIOPSY","code_information":[{"code":"20251","type":"CPT"}],"standard_charges":[{"minimum":2657.78,"maximum":14037.14,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":3796,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3212,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":14037.14,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":2657.78,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":7229.13,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":7369.5,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7299.31,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"}]}]},{"description":"BRONCHITIS AND ASTHMA WITHOUT CC/MCC","code_information":[{"code":"203","type":"MS-DRG"}],"standard_charges":[{"minimum":4482.9,"maximum":10489,"setting":"inpatient","payers_information":[{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":10489,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":9379,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":10486.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":8718,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10308,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":9509,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":4482.9,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":5230.04,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":4980.99,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":5080.61,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":5080.61,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5080.61,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5400.44,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":5269.36,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5243.14,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":5505.3,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":5374.22,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":5243.14,"methodology":"case rate"}]}]},{"description":"RESPIRATORY SIGNS AND SYMPTOMS","code_information":[{"code":"204","type":"MS-DRG"}],"standard_charges":[{"minimum":5170.98,"maximum":12211,"setting":"inpatient","payers_information":[{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":12211,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":10919,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":12095.84,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":10149,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12001,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":11070,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":5170.98,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":6032.81,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":5745.53,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":5860.45,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":5860.45,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5860.45,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6229.36,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":6078.16,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6047.92,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":6350.32,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6199.12,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":6047.92,"methodology":"case rate"}]}]},{"description":"OTHER RESPIRATORY SYSTEM DIAGNOSES WITH MCC","code_information":[{"code":"205","type":"MS-DRG"}],"standard_charges":[{"minimum":11647.66,"maximum":28425,"setting":"inpatient","payers_information":[{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":28425,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":25417,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":27245.96,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":23625,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":27936,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":25768,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":11647.66,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":13588.94,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":12941.84,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":13200.68,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":13200.68,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13200.68,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":14031.67,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":13691.1,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":13622.98,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":14304.13,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":13963.56,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":13622.98,"methodology":"case rate"}]}]},{"description":"INJECTION OF SINUS TRACT","code_information":[{"code":"20500","type":"CPT"}],"standard_charges":[{"minimum":1455.33,"maximum":2910.66,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":2910.66,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1498.99,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":1455.33,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1455.33,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":1528.1,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1513.54,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":1455.33,"methodology":"case rate"}]}]},{"description":"INJECT SINUS TRACT FOR X-RAY","code_information":[{"code":"20501","type":"CPT"}],"standard_charges":[{"minimum":1538.38,"maximum":1538.38,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"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|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC REMOVAL FB MUSC/TENDON SIM","code_information":[{"code":"20520","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":1010.1,"maximum":1010.1,"gross_charge":1110,"discounted_cash":522.91,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1010.1,"methodology":"fee schedule"}]}]},{"description":"HC REMOVAL FB MUSC/TENDON SIM","code_information":[{"code":"20520","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":260.74,"maximum":3183.7,"gross_charge":1110,"discounted_cash":522.91,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":699.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":699.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":699.3,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2376,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":2011,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":3183.7,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":699.3,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":699.3,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1538.38,"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|All Other Plans","standard_charge_dollar":532.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":832.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":299.7,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":314.69,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":293.71,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":260.74,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":305.7,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":308.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1639.61,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":1591.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1591.85,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":1671.44,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1655.52,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":1591.85,"methodology":"case rate"}]}]},{"description":"HC REMOVAL OF FOREIGN BODY","code_information":[{"code":"20525","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":2506.14,"maximum":2506.14,"gross_charge":2754,"discounted_cash":1297.37,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2506.14,"methodology":"fee schedule"}]}]},{"description":"HC REMOVAL OF FOREIGN BODY","code_information":[{"code":"20525","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":646.92,"maximum":5623.82,"gross_charge":2754,"discounted_cash":1297.37,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1735.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1735.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1735.02,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":3796,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3212,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":5623.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1735.02,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":1735.02,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2657.78,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2506.14,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1321.92,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":2065.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":743.58,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":780.76,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":728.71,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":646.92,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":758.46,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":765.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2896.27,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":2811.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2811.91,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":2952.51,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2924.39,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":2811.91,"methodology":"case rate"}]}]},{"description":"HC INJECT CARPAL TUNNEL","code_information":[{"code":"20526","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":1270.36,"maximum":1270.36,"gross_charge":1396,"discounted_cash":657.64,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1270.36,"methodology":"fee schedule"}]}]},{"description":"HC INJECT CARPAL TUNNEL","code_information":[{"code":"20526","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":290.02,"maximum":1538.38,"gross_charge":1396,"discounted_cash":657.64,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":879.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":879.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":879.48,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":580.04,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":879.48,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":879.48,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1270.36,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":670.08,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":1047,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":376.92,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":395.77,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":369.39,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":327.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":384.46,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":388.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":298.72,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":290.02,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":290.02,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":304.52,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":301.62,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":290.02,"methodology":"case rate"}]}]},{"description":"INJ DUPUYTREN CORD W/ENZYME","code_information":[{"code":"20527","type":"CPT"}],"standard_charges":[{"minimum":290.02,"maximum":1538.38,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":580.04,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":298.72,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":290.02,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":290.02,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":304.52,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":301.62,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":290.02,"methodology":"case rate"}]}]},{"description":"HC INJ TENDON SHTH/LIG SGL","code_information":[{"code":"20550","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":809.9,"maximum":809.9,"gross_charge":890,"discounted_cash":419.27,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":809.9,"methodology":"fee schedule"}]}]},{"description":"HC INJ TENDON SHTH/LIG SGL","code_information":[{"code":"20550","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":209.07,"maximum":1538.38,"gross_charge":890,"discounted_cash":419.27,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":560.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":560.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":560.7,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":580.04,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":560.7,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":560.7,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":809.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":427.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":667.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":240.3,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":252.32,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":235.5,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":209.07,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":245.11,"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":298.72,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":290.02,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":290.02,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":304.52,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":301.62,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":290.02,"methodology":"case rate"}]}]},{"description":"HC INJ TENDON ORIGIN","code_information":[{"code":"20551","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":809.9,"maximum":809.9,"gross_charge":890,"discounted_cash":419.27,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":809.9,"methodology":"fee schedule"}]}]},{"description":"HC INJ TENDON ORIGIN","code_information":[{"code":"20551","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":209.07,"maximum":1538.38,"gross_charge":890,"discounted_cash":419.27,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":560.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":560.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":560.7,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":471.7,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":418.3,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":580.04,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":560.7,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":560.7,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":809.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":427.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":667.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":240.3,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":252.32,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":235.5,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":209.07,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":245.11,"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":298.72,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":290.02,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":290.02,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":304.52,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":301.62,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":290.02,"methodology":"case rate"}]}]},{"description":"HC INJ TRIG POINT 1-2 MUSCL","code_information":[{"code":"20552","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":1365.91,"maximum":1365.91,"gross_charge":1501,"discounted_cash":707.1,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1365.91,"methodology":"fee schedule"}]}]},{"description":"HC INJ TRIG POINT 1-2 MUSCL","code_information":[{"code":"20552","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":290.02,"maximum":1538.38,"gross_charge":1501,"discounted_cash":707.1,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":945.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":945.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":945.63,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":795.53,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":705.47,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":580.04,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":945.63,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":945.63,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1365.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":720.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":1125.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":405.27,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":425.54,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":397.17,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":352.59,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":413.38,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":417.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":298.72,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":290.02,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":290.02,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":304.52,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":301.62,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":290.02,"methodology":"case rate"}]}]},{"description":"HC INJECT TRIGGER POINTS > 3","code_information":[{"code":"20553","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":1407.77,"maximum":1407.77,"gross_charge":1547,"discounted_cash":728.77,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1407.77,"methodology":"fee schedule"}]}]},{"description":"HC INJECT TRIGGER POINTS > 3","code_information":[{"code":"20553","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":290.02,"maximum":1538.38,"gross_charge":1547,"discounted_cash":728.77,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":974.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":974.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":974.61,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":819.91,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":727.09,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":580.04,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":974.61,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":974.61,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1407.77,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":742.56,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":1160.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":417.69,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":438.58,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":409.34,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":363.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":426.05,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":430.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":298.72,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":290.02,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":290.02,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":304.52,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":301.62,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":290.02,"methodology":"case rate"}]}]},{"description":"PLACE NDL MUSC/TIS FOR RT","code_information":[{"code":"20555","type":"CPT"}],"standard_charges":[{"minimum":2657.78,"maximum":6375.52,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":6375.52,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":2657.78,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3283.39,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":3187.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3187.76,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":3347.15,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3315.27,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":3187.76,"methodology":"case rate"}]}]},{"description":"HC NEEDLE INSERTION W/O INJECTION 1 OR 2 MUSCLES","code_information":[{"code":"20560","type":"CPT"},{"code":"0420","type":"RC"}],"standard_charges":[{"minimum":67.34,"maximum":67.34,"gross_charge":74,"discounted_cash":34.87,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":67.34,"methodology":"fee schedule"}]}]},{"description":"HC NEEDLE INSERTION W/O INJECTION 1 OR 2 MUSCLES","code_information":[{"code":"20560","type":"CPT"},{"code":"0420","type":"RC"}],"standard_charges":[{"minimum":17.39,"maximum":67.34,"gross_charge":74,"discounted_cash":34.87,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":46.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":46.62,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":48.12,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46.62,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":46.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":67.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":35.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":55.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":19.98,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.98,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.59,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.39,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.38,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":24.78,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":24.06,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":24.06,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":25.26,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":25.02,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":24.06,"methodology":"case rate"}]}]},{"description":"HC INJECT TRIGGER POINTS >3","code_information":[{"code":"20561","type":"CPT"},{"code":"0420","type":"RC"}],"standard_charges":[{"minimum":67.34,"maximum":67.34,"gross_charge":74,"discounted_cash":34.87,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":67.34,"methodology":"fee schedule"}]}]},{"description":"HC INJECT TRIGGER POINTS >3","code_information":[{"code":"20561","type":"CPT"},{"code":"0420","type":"RC"}],"standard_charges":[{"minimum":17.39,"maximum":67.34,"gross_charge":74,"discounted_cash":34.87,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":46.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":46.62,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":48.12,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46.62,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":46.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":67.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":35.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":55.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":19.98,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.98,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.59,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.39,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.38,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":24.78,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":24.06,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":24.06,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":25.26,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":25.02,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":24.06,"methodology":"case rate"}]}]},{"description":"OTHER RESPIRATORY SYSTEM DIAGNOSES WITHOUT MCC","code_information":[{"code":"206","type":"MS-DRG"}],"standard_charges":[{"minimum":5741.17,"maximum":13639,"setting":"inpatient","payers_information":[{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":13639,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":12196,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":13429.62,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":11336,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13404,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":12364,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":5741.17,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":6698.03,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":6379.07,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":6506.66,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":6506.66,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6506.66,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6916.26,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":6748.39,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6714.81,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":7050.56,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6882.69,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":6714.81,"methodology":"case rate"}]}]},{"description":"HC ASPIR/INJ JOINT SMALL","code_information":[{"code":"20600","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":573.3,"maximum":573.3,"gross_charge":630,"discounted_cash":296.79,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":573.3,"methodology":"fee schedule"}]}]},{"description":"HC ASPIR/INJ JOINT SMALL","code_information":[{"code":"20600","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":147.99,"maximum":1538.38,"gross_charge":630,"discounted_cash":296.79,"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":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":580.04,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":396.9,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":396.9,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":573.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":302.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":472.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":170.1,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":178.61,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":166.7,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":147.99,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":173.51,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":175.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":298.72,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":290.02,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":290.02,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":304.52,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":301.62,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":290.02,"methodology":"case rate"}]}]},{"description":"HC DRAIN/INJ JOINT/BURSA W/US","code_information":[{"code":"20604","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":702.52,"maximum":702.52,"gross_charge":772,"discounted_cash":363.68,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":702.52,"methodology":"fee schedule"}]}]},{"description":"HC DRAIN/INJ JOINT/BURSA W/US","code_information":[{"code":"20604","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":181.35,"maximum":1538.38,"gross_charge":772,"discounted_cash":363.68,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":486.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":486.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":486.36,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":580.04,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":486.36,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":486.36,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":702.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":370.56,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":579,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":208.44,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":218.87,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":204.28,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":181.35,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":212.61,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":214.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":298.72,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":290.02,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":290.02,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":304.52,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":301.62,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":290.02,"methodology":"case rate"}]}]},{"description":"HC DRAIN/INJ JOINT/BURSA W/US SMALL","code_information":[{"code":"20604","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":1312.22,"maximum":1312.22,"gross_charge":1442,"discounted_cash":679.31,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1312.22,"methodology":"fee schedule"}]}]},{"description":"HC DRAIN/INJ JOINT/BURSA W/US SMALL","code_information":[{"code":"20604","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":290.02,"maximum":1538.38,"gross_charge":1442,"discounted_cash":679.31,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":908.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":908.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":908.46,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":580.04,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":908.46,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":908.46,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1312.22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":692.16,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":1081.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":389.34,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":408.81,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":381.56,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":338.73,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":397.13,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":401.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":298.72,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":290.02,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":290.02,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":304.52,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":301.62,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":290.02,"methodology":"case rate"}]}]},{"description":"HC ASPIR/INJ JOINT INTERM","code_information":[{"code":"20605","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":573.3,"maximum":573.3,"gross_charge":630,"discounted_cash":296.79,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":573.3,"methodology":"fee schedule"}]}]},{"description":"HC ASPIR/INJ JOINT INTERM","code_information":[{"code":"20605","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":147.99,"maximum":1538.38,"gross_charge":630,"discounted_cash":296.79,"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":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":580.04,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":396.9,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":396.9,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":573.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":302.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":472.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":170.1,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":178.61,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":166.7,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":147.99,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":173.51,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":175.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":298.72,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":290.02,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":290.02,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":304.52,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":301.62,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":290.02,"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":1885.52,"maximum":1885.52,"gross_charge":2072,"discounted_cash":976.09,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1885.52,"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":486.72,"maximum":1885.52,"gross_charge":2072,"discounted_cash":976.09,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1305.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1305.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1305.36,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":1360.78,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1305.36,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":1305.36,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1885.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":994.56,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":1554,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":559.44,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":587.42,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":548.26,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":486.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":570.63,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":576.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":700.8,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":680.39,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":680.39,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":714.41,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":707.61,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":680.39,"methodology":"case rate"}]}]},{"description":"HC ASPIR/INJ JOINT MAJOR","code_information":[{"code":"20610","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":795.34,"maximum":795.34,"gross_charge":874,"discounted_cash":411.73,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":795.34,"methodology":"fee schedule"}]}]},{"description":"HC ASPIR/INJ JOINT MAJOR","code_information":[{"code":"20610","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":205.31,"maximum":2152,"gross_charge":874,"discounted_cash":411.73,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":550.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":550.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":550.62,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2152,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":1821,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":580.04,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":550.62,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":550.62,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":795.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":419.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":655.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":235.98,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":247.78,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":231.27,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":205.31,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":240.7,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":243.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":298.72,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":290.02,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":290.02,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":304.52,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":301.62,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":290.02,"methodology":"case rate"}]}]},{"description":"HC ASPIRATION/INJECTION MAJOR JOINT","code_information":[{"code":"20610","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":850.85,"maximum":850.85,"gross_charge":935,"discounted_cash":440.47,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":850.85,"methodology":"fee schedule"}]}]},{"description":"HC ASPIRATION/INJECTION MAJOR JOINT","code_information":[{"code":"20610","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":219.64,"maximum":2152,"gross_charge":935,"discounted_cash":440.47,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":589.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":589.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":589.05,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2152,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":1821,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":580.04,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":589.05,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":589.05,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":850.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":448.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":701.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":252.45,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":265.08,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":247.41,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":219.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":257.5,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":260.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":298.72,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":290.02,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":290.02,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":304.52,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":301.62,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":290.02,"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":1848.21,"maximum":1848.21,"gross_charge":2031,"discounted_cash":956.77,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1848.21,"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":290.02,"maximum":1848.21,"gross_charge":2031,"discounted_cash":956.77,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1279.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1279.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1279.53,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":580.04,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1279.53,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":1279.53,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1848.21,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":974.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":1523.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":548.37,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":575.79,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":537.41,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":477.09,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":559.34,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":564.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":298.72,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":290.02,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":290.02,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":304.52,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":301.62,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":290.02,"methodology":"case rate"}]}]},{"description":"HC ASPIR/INJ GANGLION CYST","code_information":[{"code":"20612","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":645.19,"maximum":645.19,"gross_charge":709,"discounted_cash":334,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":645.19,"methodology":"fee schedule"}]}]},{"description":"HC ASPIR/INJ GANGLION CYST","code_information":[{"code":"20612","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":166.55,"maximum":1538.38,"gross_charge":709,"discounted_cash":334,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":446.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":446.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":446.67,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":580.04,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":446.67,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":446.67,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":645.19,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":340.32,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":531.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":191.43,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":201.01,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":187.61,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":166.55,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":195.26,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":197.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":298.72,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":290.02,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":290.02,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":304.52,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":301.62,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":290.02,"methodology":"case rate"}]}]},{"description":"TREATMENT OF BONE CYST","code_information":[{"code":"20615","type":"CPT"}],"standard_charges":[{"minimum":691.26,"maximum":1538.38,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":1382.52,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":712,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":691.26,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":691.26,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":725.82,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":718.91,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":691.26,"methodology":"case rate"}]}]},{"description":"INSERT AND REMOVE BONE PIN","code_information":[{"code":"20650","type":"CPT"}],"standard_charges":[{"minimum":2657.78,"maximum":6375.52,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":3796,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3212,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":6375.52,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":2657.78,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3283.39,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":3187.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3187.76,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":3347.15,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3315.27,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":3187.76,"methodology":"case rate"}]}]},{"description":"APPLY REM FIXATION DEVICE","code_information":[{"code":"20660","type":"CPT"}],"standard_charges":[{"minimum":1538.38,"maximum":3144.74,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":3144.74,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1619.54,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":1572.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1572.37,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":1650.99,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1635.26,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":1572.37,"methodology":"case rate"}]}]},{"description":"APPLICATION OF HEAD BRACE","code_information":[{"code":"20661","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"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|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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":52,"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":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"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":1538.38,"maximum":3144.74,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":3144.74,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1619.54,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":1572.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1572.37,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":1650.99,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1635.26,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":1572.37,"methodology":"case rate"}]}]},{"description":"APPLICATION OF THIGH BRACE","code_information":[{"code":"20663","type":"CPT"}],"standard_charges":[{"minimum":2657.78,"maximum":6375.52,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":6375.52,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":2657.78,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3283.39,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":3187.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3187.76,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":3347.15,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3315.27,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":3187.76,"methodology":"case rate"}]}]},{"description":"APPLICATION OF HALO","code_information":[{"code":"20664","type":"CPT"}],"standard_charges":[{"minimum":1538.38,"maximum":1538.38,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"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|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"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":392.05,"maximum":1538.38,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":784.1,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":403.81,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":392.05,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":392.05,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":411.65,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":407.73,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":392.05,"methodology":"case rate"}]}]},{"description":"HC REMOVAL SUPERFICIAL IMPLANT","code_information":[{"code":"20670","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":2361.45,"maximum":2361.45,"gross_charge":2595,"discounted_cash":1222.47,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2361.45,"methodology":"fee schedule"}]}]},{"description":"HC REMOVAL SUPERFICIAL IMPLANT","code_information":[{"code":"20670","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":609.57,"maximum":3183.7,"gross_charge":2595,"discounted_cash":1222.47,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1634.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1634.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1634.85,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2152,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":1821,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":3183.7,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1634.85,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":1634.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2361.45,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1245.6,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":1946.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":700.65,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":735.69,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":686.64,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":609.57,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":714.67,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":721.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1639.61,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":1591.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1591.85,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":1671.44,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1655.52,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":1591.85,"methodology":"case rate"}]}]},{"description":"REMOVAL OF SUPPORT IMPLANT","code_information":[{"code":"20680","type":"CPT"}],"standard_charges":[{"minimum":2657.78,"maximum":5623.82,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":3796,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3212,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":5623.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":2657.78,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"median_amount":2738.82,"10th_percentile":2738.82,"90th_percentile":2738.82,"count":"1 through 10","methodology":"percent of total billed charges"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"median_amount":4679.05,"10th_percentile":4679.05,"90th_percentile":4679.05,"count":"1 through 10","methodology":"percent of total billed charges"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"median_amount":3152.18,"10th_percentile":3152.18,"90th_percentile":3152.18,"count":"1 through 10","methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"median_amount":1938.47,"10th_percentile":1938.47,"90th_percentile":1938.47,"count":"1 through 10","methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2896.27,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":2811.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2811.91,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":2952.51,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2924.39,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":2811.91,"methodology":"case rate"}]}]},{"description":"APPLY BONE FIXATION DEVICE","code_information":[{"code":"20690","type":"CPT"}],"standard_charges":[{"minimum":1923.63,"maximum":14037.14,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2376,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":2011,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":14037.14,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1923.63,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":7229.13,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":7369.5,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7299.31,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"}]}]},{"description":"APPLY BONE FIXATION DEVICE","code_information":[{"code":"20692","type":"CPT"}],"standard_charges":[{"minimum":2657.78,"maximum":25282.78,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":3796,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3212,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":25282.78,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":2657.78,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":13020.63,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":12641.39,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":12641.39,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":13273.46,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":13147.05,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":12641.39,"methodology":"case rate"}]}]},{"description":"ADJUST BONE FIXATION DEVICE","code_information":[{"code":"20693","type":"CPT"}],"standard_charges":[{"minimum":2657.78,"maximum":14037.14,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":3796,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3212,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":14037.14,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":2657.78,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":7229.13,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":7369.5,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7299.31,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"}]}]},{"description":"REMOVE BONE FIXATION DEVICE","code_information":[{"code":"20694","type":"CPT"}],"standard_charges":[{"minimum":1538.38,"maximum":3144.74,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2152,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":1821,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":3144.74,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1619.54,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":1572.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1572.37,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":1650.99,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1635.26,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":1572.37,"methodology":"case rate"}]}]},{"description":"COMP MULTIPLANE EXT FIXATION","code_information":[{"code":"20696","type":"CPT"}],"standard_charges":[{"minimum":2657.78,"maximum":36135.72,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":36135.72,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":2657.78,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":18609.9,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":18067.86,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":18067.86,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":18971.25,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":18790.57,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":18067.86,"methodology":"case rate"}]}]},{"description":"COMP EXT FIXATE STRUT CHANGE","code_information":[{"code":"20697","type":"CPT"}],"standard_charges":[{"minimum":1538.38,"maximum":3144.74,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":3144.74,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1619.54,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":1572.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1572.37,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":1650.99,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1635.26,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":1572.37,"methodology":"case rate"}]}]},{"description":"RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT >96 HOURS","code_information":[{"code":"207","type":"MS-DRG"}],"standard_charges":[{"minimum":39191.58,"maximum":97377,"setting":"inpatient","payers_information":[{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":97377,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":87074,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":91676.2,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":80934,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":95702,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":88277,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":39191.58,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":45723.51,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":43546.2,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":44417.13,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":44417.13,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":44417.13,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":47213.25,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":46067.3,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":45838.1,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":48130.01,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":46984.06,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":45838.1,"methodology":"case rate"}]}]},{"description":"MNL PREPINSJ DP RX DLVR DEV","code_information":[{"code":"20700","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"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|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"median_amount":1074.23,"10th_percentile":1074.23,"90th_percentile":1074.23,"count":"1 through 10","methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"median_amount":927.27,"10th_percentile":927.27,"90th_percentile":927.27,"count":"1 through 10","methodology":"percent of total billed charges"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"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":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"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|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"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":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"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|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"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":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"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|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"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":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"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|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"median_amount":10435,"10th_percentile":10435,"90th_percentile":10435,"count":"1 through 10","methodology":"percent of total billed charges"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"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":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"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|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT <=96 HOURS","code_information":[{"code":"208","type":"MS-DRG"}],"standard_charges":[{"minimum":16435.39,"maximum":40410,"setting":"inpatient","payers_information":[{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":40410,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":36135,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":38445.34,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":33587,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":39715,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":36634,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":16435.39,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":19174.62,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":18261.54,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":18626.78,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":18626.78,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":18626.78,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":19799.36,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":19318.79,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":19222.67,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":20183.81,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":19703.24,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":19222.67,"methodology":"case rate"}]}]},{"description":"REPLANTATION ARM COMPLETE","code_information":[{"code":"20802","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"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|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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":52,"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":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"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":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"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|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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":52,"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":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"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":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"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|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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":52,"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":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"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":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"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|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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":52,"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":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC REPLANTATION DIGIT DISTAL COMPLT","code_information":[{"code":"20822","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":4035.85,"maximum":4035.85,"gross_charge":4435,"discounted_cash":2089.26,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4035.85,"methodology":"fee schedule"}]}]},{"description":"HC REPLANTATION DIGIT DISTAL COMPLT","code_information":[{"code":"20822","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":1041.79,"maximum":4035.85,"gross_charge":4435,"discounted_cash":2089.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2794.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2794.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2794.05,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2350.55,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":2084.45,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":3144.74,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2794.05,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2794.05,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1923.63,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4035.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2128.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":3326.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":1197.45,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":1257.33,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":1173.51,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":1041.79,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1221.4,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1233.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1619.54,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":1572.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1572.37,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":1650.99,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1635.26,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":1572.37,"methodology":"case rate"}]}]},{"description":"REPLANTATION THUMB COMPLETE","code_information":[{"code":"20824","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"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|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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":52,"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":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"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":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"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|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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":52,"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":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"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":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"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|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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":52,"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":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REMOVAL OF BONE FOR GRAFT","code_information":[{"code":"20900","type":"CPT"}],"standard_charges":[{"minimum":2657.78,"maximum":14037.14,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":3796,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3212,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":14037.14,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":2657.78,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":7229.13,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":7369.5,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7299.31,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"}]}]},{"description":"REMOVAL OF BONE FOR GRAFT","code_information":[{"code":"20902","type":"CPT"}],"standard_charges":[{"minimum":3078.06,"maximum":14037.14,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":4157,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3517,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":14037.14,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":3078.06,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":7229.13,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":7369.5,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7299.31,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"}]}]},{"description":"REMOVE CARTILAGE FOR GRAFT","code_information":[{"code":"20910","type":"CPT"}],"standard_charges":[{"minimum":601.41,"maximum":3796,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":3796,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3212,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":1202.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":2657.78,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":619.45,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":601.41,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":601.41,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":631.48,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":625.47,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":601.41,"methodology":"case rate"}]}]},{"description":"REMOVE CARTILAGE FOR GRAFT","code_information":[{"code":"20912","type":"CPT"}],"standard_charges":[{"minimum":2657.78,"maximum":7193.66,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":3796,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3212,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":7193.66,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":2657.78,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3704.73,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":3596.83,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3596.83,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":3776.67,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3740.7,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":3596.83,"methodology":"case rate"}]}]},{"description":"REMOVAL OF FASCIA FOR GRAFT","code_information":[{"code":"20920","type":"CPT"}],"standard_charges":[{"minimum":1797.18,"maximum":4157,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":4157,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3517,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":3594.36,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":3078.06,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1851.1,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":1797.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1797.18,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":1887.04,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1869.07,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":1797.18,"methodology":"case rate"}]}]},{"description":"REMOVAL OF FASCIA FOR GRAFT","code_information":[{"code":"20922","type":"CPT"}],"standard_charges":[{"minimum":1797.18,"maximum":3796,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":3796,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3212,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":3594.36,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":2657.78,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1851.1,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":1797.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1797.18,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":1887.04,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1869.07,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":1797.18,"methodology":"case rate"}]}]},{"description":"REMOVAL OF TENDON FOR GRAFT","code_information":[{"code":"20924","type":"CPT"}],"standard_charges":[{"minimum":3078.06,"maximum":14037.14,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":4157,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3517,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":14037.14,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":3078.06,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":7229.13,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":7369.5,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7299.31,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"}]}]},{"description":"SP BONE ALGRFT MORSEL ADD-ON","code_information":[{"code":"20930","type":"CPT"}],"standard_charges":[{"minimum":1538.38,"maximum":1538.38,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"median_amount":4101.05,"10th_percentile":4101.05,"90th_percentile":4101.05,"count":"1 through 10","methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"median_amount":4101.05,"10th_percentile":4101.05,"90th_percentile":4101.05,"count":"1 through 10","methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"median_amount":4101.05,"10th_percentile":4101.05,"90th_percentile":4101.05,"count":"1 through 10","methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"median_amount":1942.01,"10th_percentile":1601.43,"90th_percentile":4800.37,"count":"1 through 10","methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"median_amount":1942.01,"10th_percentile":1601.43,"90th_percentile":4800.37,"count":"1 through 10","methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_percentage":48,"median_amount":2092.77,"10th_percentile":1181.89,"90th_percentile":8475.84,"count":"1 through 10","methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"median_amount":1393.42,"10th_percentile":1393.42,"90th_percentile":1393.42,"count":"1 through 10","methodology":"percent of total billed charges"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"median_amount":3977.74,"10th_percentile":3977.74,"90th_percentile":3977.74,"count":"1 through 10","methodology":"percent of total billed charges"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"median_amount":900.68,"10th_percentile":900.68,"90th_percentile":900.68,"count":"1 through 10","methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"median_amount":553.21,"10th_percentile":553.21,"90th_percentile":553.21,"count":"1 through 10","methodology":"percent of total billed charges"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"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":1538.38,"maximum":1538.38,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"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|All Other Plans","standard_charge_percentage":63,"median_amount":2956.81,"10th_percentile":2956.81,"90th_percentile":2956.81,"count":"1 through 10","methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"median_amount":2956.81,"10th_percentile":2956.81,"90th_percentile":2956.81,"count":"1 through 10","methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_percentage":48,"median_amount":1227.16,"10th_percentile":1227.16,"90th_percentile":1227.16,"count":"1 through 10","methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"median_amount":1756.83,"10th_percentile":686.67,"90th_percentile":1756.83,"count":"1 through 10","methodology":"percent of total billed charges"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"median_amount":953.88,"10th_percentile":953.88,"90th_percentile":953.88,"count":"1 through 10","methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"median_amount":768.69,"10th_percentile":768.69,"90th_percentile":768.69,"count":"1 through 10","methodology":"percent of total billed charges"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"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":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"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|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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":52,"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":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"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":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"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|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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":52,"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":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"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":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"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|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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":52,"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":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"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":1538.38,"maximum":1538.38,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"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|All Other Plans","standard_charge_percentage":63,"median_amount":1601.41,"10th_percentile":1601.41,"90th_percentile":1601.41,"count":"1 through 10","methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"median_amount":1601.41,"10th_percentile":1601.41,"90th_percentile":1601.41,"count":"1 through 10","methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_percentage":48,"median_amount":2092.77,"10th_percentile":1181.87,"90th_percentile":3110.8,"count":"1 through 10","methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"median_amount":3977.71,"10th_percentile":3977.71,"90th_percentile":3977.71,"count":"1 through 10","methodology":"percent of total billed charges"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"median_amount":953.86,"10th_percentile":953.86,"90th_percentile":953.86,"count":"1 through 10","methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"median_amount":1059.47,"10th_percentile":553.21,"90th_percentile":1853.07,"count":"1 through 10","methodology":"percent of total billed charges"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"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":1538.38,"maximum":1538.38,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"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|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"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":1538.38,"maximum":1538.38,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"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|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"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":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"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|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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":52,"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":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC FLUID PRESSURE MUSCLE","code_information":[{"code":"20950","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":405.86,"maximum":405.86,"gross_charge":446,"discounted_cash":210.11,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":405.86,"methodology":"fee schedule"}]}]},{"description":"HC FLUID PRESSURE MUSCLE","code_information":[{"code":"20950","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":104.77,"maximum":1538.38,"gross_charge":446,"discounted_cash":210.11,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":280.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":280.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":280.98,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":236.38,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":209.62,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":1382.52,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":280.98,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":280.98,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":405.86,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":214.08,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":334.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":120.42,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":126.45,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":118.02,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":104.77,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":122.83,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":124.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":712,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":691.26,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":691.26,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":725.82,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":718.91,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":691.26,"methodology":"case rate"}]}]},{"description":"FIBULA BONE GRAFT MICROVASC","code_information":[{"code":"20955","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"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|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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":52,"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":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"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":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"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|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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":52,"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":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"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":3497.02,"maximum":3497.02,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"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|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":3497.02,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"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":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"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|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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":52,"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":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"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":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"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|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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":52,"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":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"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":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"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|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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":52,"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":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"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":4336.27,"maximum":14037.14,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":14037.14,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":4336.27,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":7229.13,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":7369.5,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7299.31,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"}]}]},{"description":"BONE/SKIN GRAFT GREAT TOE","code_information":[{"code":"20973","type":"CPT"}],"standard_charges":[{"minimum":4336.27,"maximum":14037.14,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":14037.14,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":4336.27,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":7229.13,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":7369.5,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7299.31,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"}]}]},{"description":"ELECTRICAL BONE STIMULATION","code_information":[{"code":"20974","type":"CPT"}],"standard_charges":[{"minimum":76.41,"maximum":1538.38,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":152.82,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":78.7,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":76.41,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":76.41,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":80.23,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":79.47,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":76.41,"methodology":"fee schedule"}]}]},{"description":"ELECTRICAL BONE STIMULATION","code_information":[{"code":"20975","type":"CPT"}],"standard_charges":[{"minimum":1923.63,"maximum":2376,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2376,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":2011,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1923.63,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"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":24.06,"maximum":1538.38,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":48.12,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":24.78,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":24.06,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":24.06,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":25.26,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":25.02,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":24.06,"methodology":"case rate"}]}]},{"description":"ABLATE BONE TUMOR(S) PERQ","code_information":[{"code":"20982","type":"CPT"}],"standard_charges":[{"minimum":4266.22,"maximum":25282.78,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":25282.78,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":4266.22,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":13020.63,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":12641.39,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":12641.39,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":13273.46,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":13147.05,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":12641.39,"methodology":"case rate"}]}]},{"description":"ABLATE BONE TUMOR(S) PERQ","code_information":[{"code":"20983","type":"CPT"}],"standard_charges":[{"minimum":4266.22,"maximum":14037.14,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":14037.14,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":4266.22,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":7229.13,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":7369.5,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7299.31,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"}]}]},{"description":"CPTR-ASST DIR MS PX","code_information":[{"code":"20985","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"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|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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":52,"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":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"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":235.68,"maximum":1538.38,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":471.36,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":242.75,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":235.68,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":235.68,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":247.46,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":245.11,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":235.68,"methodology":"case rate"}]}]},{"description":"HC ROOM CHARGE CCU ICU TELE","code_information":[{"code":"2100000001","type":"CDM"},{"code":"0210","type":"RC"}],"standard_charges":[{"minimum":4683.77,"maximum":4683.77,"gross_charge":5147,"discounted_cash":2424.67,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6725,"methodology":"per diem"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6725,"methodology":"per diem"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6725,"methodology":"per diem"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3588,"methodology":"per diem"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3588,"methodology":"per diem"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4683.77,"methodology":"fee schedule"}]}]},{"description":"INCISION OF JAW JOINT","code_information":[{"code":"21010","type":"CPT"}],"standard_charges":[{"minimum":1923.63,"maximum":6372.5,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2376,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":2011,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":6372.5,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1923.63,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3281.84,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":3186.25,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3186.25,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":3345.56,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3313.7,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":3186.25,"methodology":"case rate"}]}]},{"description":"EXC FACE LES SC <2 CM","code_information":[{"code":"21011","type":"CPT"}],"standard_charges":[{"minimum":1538.38,"maximum":3183.7,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2376,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":2011,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":3183.7,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1639.61,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":1591.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1591.85,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":1671.44,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1655.52,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":1591.85,"methodology":"case rate"}]}]},{"description":"EXC FACE LES SBQ 2 CM/>","code_information":[{"code":"21012","type":"CPT"}],"standard_charges":[{"minimum":1538.38,"maximum":3183.7,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2376,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":2011,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":3183.7,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1639.61,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":1591.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1591.85,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":1671.44,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1655.52,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":1591.85,"methodology":"case rate"}]}]},{"description":"EXC FACE TUM DEEP < 2 CM","code_information":[{"code":"21013","type":"CPT"}],"standard_charges":[{"minimum":1538.38,"maximum":3183.7,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2376,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":2011,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":3183.7,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1639.61,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":1591.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1591.85,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":1671.44,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1655.52,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":1591.85,"methodology":"case rate"}]}]},{"description":"EXC FACE TUM DEEP 2 CM/>","code_information":[{"code":"21014","type":"CPT"}],"standard_charges":[{"minimum":1538.38,"maximum":5623.82,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2376,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":2011,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":5623.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2896.27,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":2811.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2811.91,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":2952.51,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2924.39,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":2811.91,"methodology":"case rate"}]}]},{"description":"RESECT FACE/SCALP TUM < 2 CM","code_information":[{"code":"21015","type":"CPT"}],"standard_charges":[{"minimum":2657.78,"maximum":5623.82,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":3796,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3212,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":5623.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":2657.78,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2896.27,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":2811.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2811.91,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":2952.51,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2924.39,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":2811.91,"methodology":"case rate"}]}]},{"description":"RESECT FACE/SCALP TUM 2 CM/>","code_information":[{"code":"21016","type":"CPT"}],"standard_charges":[{"minimum":1538.38,"maximum":5623.82,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":5623.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2896.27,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":2811.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2811.91,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":2952.51,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2924.39,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":2811.91,"methodology":"case rate"}]}]},{"description":"EXCISION OF BONE LOWER JAW","code_information":[{"code":"21025","type":"CPT"}],"standard_charges":[{"minimum":1923.63,"maximum":11624.04,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2376,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":2011,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":11624.04,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1923.63,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5986.38,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":5812.02,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5812.02,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":6102.62,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6044.5,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":5812.02,"methodology":"case rate"}]}]},{"description":"EXCISION OF FACIAL BONE(S)","code_information":[{"code":"21026","type":"CPT"}],"standard_charges":[{"minimum":1923.63,"maximum":11624.04,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2376,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":2011,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":11624.04,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1923.63,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5986.38,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":5812.02,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5812.02,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":6102.62,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6044.5,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":5812.02,"methodology":"case rate"}]}]},{"description":"CONTOUR OF FACE BONE LESION","code_information":[{"code":"21029","type":"CPT"}],"standard_charges":[{"minimum":1923.63,"maximum":6372.5,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2376,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":2011,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":6372.5,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1923.63,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3281.84,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":3186.25,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3186.25,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":3345.56,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3313.7,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":3186.25,"methodology":"case rate"}]}]},{"description":"EXCISE MAX/ZYGOMA B9 TUMOR","code_information":[{"code":"21030","type":"CPT"}],"standard_charges":[{"minimum":1923.63,"maximum":11624.04,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":11624.04,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1923.63,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5986.38,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":5812.02,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5812.02,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":6102.62,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6044.5,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":5812.02,"methodology":"case rate"}]}]},{"description":"REMOVE EXOSTOSIS MANDIBLE","code_information":[{"code":"21031","type":"CPT"}],"standard_charges":[{"minimum":1923.63,"maximum":6372.5,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":3796,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3212,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":6372.5,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1923.63,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3281.84,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":3186.25,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3186.25,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":3345.56,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3313.7,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":3186.25,"methodology":"case rate"}]}]},{"description":"REMOVE EXOSTOSIS MAXILLA","code_information":[{"code":"21032","type":"CPT"}],"standard_charges":[{"minimum":1923.63,"maximum":6372.5,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":6372.5,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1923.63,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3281.84,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":3186.25,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3186.25,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":3345.56,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3313.7,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":3186.25,"methodology":"case rate"}]}]},{"description":"EXCISE MAX/ZYGOMA MAL TUMOR","code_information":[{"code":"21034","type":"CPT"}],"standard_charges":[{"minimum":2657.78,"maximum":11624.04,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":3796,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3212,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":11624.04,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":2657.78,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5986.38,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":5812.02,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5812.02,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":6102.62,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6044.5,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":5812.02,"methodology":"case rate"}]}]},{"description":"EXCISE MANDIBLE LESION","code_information":[{"code":"21040","type":"CPT"}],"standard_charges":[{"minimum":1923.63,"maximum":6372.5,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2376,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":2011,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":6372.5,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1923.63,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3281.84,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":3186.25,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3186.25,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":3345.56,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3313.7,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":3186.25,"methodology":"case rate"}]}]},{"description":"REMOVAL OF JAW BONE LESION","code_information":[{"code":"21044","type":"CPT"}],"standard_charges":[{"minimum":1923.63,"maximum":11624.04,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2376,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":2011,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":11624.04,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1923.63,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5986.38,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":5812.02,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5812.02,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":6102.62,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6044.5,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":5812.02,"methodology":"case rate"}]}]},{"description":"EXTENSIVE JAW SURGERY","code_information":[{"code":"21045","type":"CPT"}],"standard_charges":[{"minimum":1538.38,"maximum":1538.38,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"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|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"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":1923.63,"maximum":11624.04,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2376,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":2011,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":11624.04,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1923.63,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5986.38,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":5812.02,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5812.02,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":6102.62,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6044.5,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":5812.02,"methodology":"case rate"}]}]},{"description":"EXCISE LWR JAW CYST W/REPAIR","code_information":[{"code":"21047","type":"CPT"}],"standard_charges":[{"minimum":1923.63,"maximum":11624.04,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2376,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":2011,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":11624.04,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1923.63,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5986.38,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":5812.02,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5812.02,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":6102.62,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6044.5,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":5812.02,"methodology":"case rate"}]}]},{"description":"REMOVE MAXILLA CYST COMPLEX","code_information":[{"code":"21048","type":"CPT"}],"standard_charges":[{"minimum":3517,"maximum":11624.04,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":4157,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3517,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":11624.04,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":4266.22,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5986.38,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":5812.02,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5812.02,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":6102.62,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6044.5,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":5812.02,"methodology":"case rate"}]}]},{"description":"EXCIS UPPR JAW CYST W/REPAIR","code_information":[{"code":"21049","type":"CPT"}],"standard_charges":[{"minimum":4266.22,"maximum":11624.04,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":11624.04,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":4266.22,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5986.38,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":5812.02,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5812.02,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":6102.62,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6044.5,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":5812.02,"methodology":"case rate"}]}]},{"description":"REMOVAL OF JAW JOINT","code_information":[{"code":"21050","type":"CPT"}],"standard_charges":[{"minimum":2657.78,"maximum":11624.04,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":3796,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3212,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":11624.04,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":2657.78,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5986.38,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":5812.02,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5812.02,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":6102.62,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6044.5,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":5812.02,"methodology":"case rate"}]}]},{"description":"REMOVE JAW JOINT CARTILAGE","code_information":[{"code":"21060","type":"CPT"}],"standard_charges":[{"minimum":1923.63,"maximum":11624.04,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2376,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":2011,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":11624.04,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1923.63,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5986.38,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":5812.02,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5812.02,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":6102.62,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6044.5,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":5812.02,"methodology":"case rate"}]}]},{"description":"REMOVE CORONOID PROCESS","code_information":[{"code":"21070","type":"CPT"}],"standard_charges":[{"minimum":2657.78,"maximum":11624.04,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":3796,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3212,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":11624.04,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":2657.78,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5986.38,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":5812.02,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5812.02,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":6102.62,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6044.5,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":5812.02,"methodology":"case rate"}]}]},{"description":"MNPJ OF TMJ W/ANESTH","code_information":[{"code":"21073","type":"CPT"}],"standard_charges":[{"minimum":1455.33,"maximum":3796,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":3796,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3212,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":2910.66,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1923.63,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1498.99,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":1455.33,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1455.33,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":1528.1,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1513.54,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":1455.33,"methodology":"case rate"}]}]},{"description":"PREPARE FACE/ORAL PROSTHESIS","code_information":[{"code":"21076","type":"CPT"}],"standard_charges":[{"minimum":1455.33,"maximum":3078.06,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":2910.66,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":3078.06,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1498.99,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":1455.33,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1455.33,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":1528.1,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1513.54,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":1455.33,"methodology":"case rate"}]}]},{"description":"PREPARE FACE/ORAL PROSTHESIS","code_information":[{"code":"21077","type":"CPT"}],"standard_charges":[{"minimum":4266.22,"maximum":11624.04,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":11624.04,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":4266.22,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5986.38,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":5812.02,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5812.02,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":6102.62,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6044.5,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":5812.02,"methodology":"case rate"}]}]},{"description":"PREPARE FACE/ORAL PROSTHESIS","code_information":[{"code":"21079","type":"CPT"}],"standard_charges":[{"minimum":3186.25,"maximum":6372.5,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":6372.5,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":3497.02,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3281.84,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":3186.25,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3186.25,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":3345.56,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3313.7,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":3186.25,"methodology":"case rate"}]}]},{"description":"PREPARE FACE/ORAL PROSTHESIS","code_information":[{"code":"21080","type":"CPT"}],"standard_charges":[{"minimum":3186.25,"maximum":6372.5,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":6372.5,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":3497.02,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3281.84,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":3186.25,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3186.25,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":3345.56,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3313.7,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":3186.25,"methodology":"case rate"}]}]},{"description":"PREPARE FACE/ORAL PROSTHESIS","code_information":[{"code":"21081","type":"CPT"}],"standard_charges":[{"minimum":3497.02,"maximum":11624.04,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":11624.04,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":3497.02,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5986.38,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":5812.02,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5812.02,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":6102.62,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6044.5,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":5812.02,"methodology":"case rate"}]}]},{"description":"PREPARE FACE/ORAL PROSTHESIS","code_information":[{"code":"21082","type":"CPT"}],"standard_charges":[{"minimum":3186.25,"maximum":6372.5,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":6372.5,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":3497.02,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3281.84,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":3186.25,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3186.25,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":3345.56,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3313.7,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":3186.25,"methodology":"case rate"}]}]},{"description":"PREPARE FACE/ORAL PROSTHESIS","code_information":[{"code":"21083","type":"CPT"}],"standard_charges":[{"minimum":3186.25,"maximum":6372.5,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":6372.5,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":3497.02,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3281.84,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":3186.25,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3186.25,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":3345.56,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3313.7,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":3186.25,"methodology":"case rate"}]}]},{"description":"PREPARE FACE/ORAL PROSTHESIS","code_information":[{"code":"21084","type":"CPT"}],"standard_charges":[{"minimum":3186.25,"maximum":6372.5,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":6372.5,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":3497.02,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3281.84,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":3186.25,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3186.25,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":3345.56,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3313.7,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":3186.25,"methodology":"case rate"}]}]},{"description":"PREPARE FACE/ORAL PROSTHESIS","code_information":[{"code":"21085","type":"CPT"}],"standard_charges":[{"minimum":228.15,"maximum":1923.63,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":456.3,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1923.63,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":234.99,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":228.15,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":228.15,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":239.56,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":237.28,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":228.15,"methodology":"case rate"}]}]},{"description":"PREPARE FACE/ORAL PROSTHESIS","code_information":[{"code":"21086","type":"CPT"}],"standard_charges":[{"minimum":3186.25,"maximum":6372.5,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":6372.5,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":3497.02,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3281.84,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":3186.25,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3186.25,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":3345.56,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3313.7,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":3186.25,"methodology":"case rate"}]}]},{"description":"PREPARE FACE/ORAL PROSTHESIS","code_information":[{"code":"21087","type":"CPT"}],"standard_charges":[{"minimum":3497.02,"maximum":11624.04,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":11624.04,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":3497.02,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5986.38,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":5812.02,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5812.02,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":6102.62,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6044.5,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":5812.02,"methodology":"case rate"}]}]},{"description":"PREPARE FACE/ORAL PROSTHESIS","code_information":[{"code":"21088","type":"CPT"}],"standard_charges":[{"minimum":3186.25,"maximum":6372.5,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":6372.5,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":3497.02,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3281.84,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":3186.25,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3186.25,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":3345.56,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3313.7,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":3186.25,"methodology":"case rate"}]}]},{"description":"PREPARE FACE/ORAL PROSTHESIS","code_information":[{"code":"21089","type":"CPT"}],"standard_charges":[{"minimum":228.15,"maximum":1538.38,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":456.3,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":234.99,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":228.15,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":228.15,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":239.56,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":237.28,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":228.15,"methodology":"case rate"}]}]},{"description":"MAXILLOFACIAL FIXATION","code_information":[{"code":"21100","type":"CPT"}],"standard_charges":[{"minimum":1923.63,"maximum":11624.04,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2376,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":2011,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":11624.04,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1923.63,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5986.38,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":5812.02,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5812.02,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":6102.62,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6044.5,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":5812.02,"methodology":"case rate"}]}]},{"description":"HC INTERDENTAL FIXATION","code_information":[{"code":"21110","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":1343.16,"maximum":1343.16,"gross_charge":1476,"discounted_cash":695.32,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1343.16,"methodology":"fee schedule"}]}]},{"description":"HC INTERDENTAL FIXATION","code_information":[{"code":"21110","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":346.72,"maximum":2910.66,"gross_charge":1476,"discounted_cash":695.32,"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":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":782.28,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":693.72,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":2910.66,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":929.88,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":929.88,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1343.16,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":708.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":1107,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":398.52,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":418.45,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":390.55,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":346.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":406.5,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":410.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1498.99,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":1455.33,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1455.33,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":1528.1,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1513.54,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":1455.33,"methodology":"case rate"}]}]},{"description":"INJECTION JAW JOINT X-RAY","code_information":[{"code":"21116","type":"CPT"}],"standard_charges":[{"minimum":1538.38,"maximum":1538.38,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"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|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"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":4336.27,"maximum":11624.04,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":5489,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":4645,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":11624.04,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":4336.27,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5986.38,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":5812.02,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5812.02,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":6102.62,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6044.5,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":5812.02,"methodology":"case rate"}]}]},{"description":"RECONSTRUCTION OF CHIN","code_information":[{"code":"21121","type":"CPT"}],"standard_charges":[{"minimum":3186.25,"maximum":6372.5,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":5489,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":4645,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":6372.5,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":4336.27,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3281.84,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":3186.25,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3186.25,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":3345.56,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3313.7,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":3186.25,"methodology":"case rate"}]}]},{"description":"RECONSTRUCTION OF CHIN","code_information":[{"code":"21122","type":"CPT"}],"standard_charges":[{"minimum":4336.27,"maximum":11624.04,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":5489,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":4645,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":11624.04,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":4336.27,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5986.38,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":5812.02,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5812.02,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":6102.62,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6044.5,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":5812.02,"methodology":"case rate"}]}]},{"description":"RECONSTRUCTION OF CHIN","code_information":[{"code":"21123","type":"CPT"}],"standard_charges":[{"minimum":3186.25,"maximum":6372.5,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":5489,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":4645,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":6372.5,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":4336.27,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3281.84,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":3186.25,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3186.25,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":3345.56,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3313.7,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":3186.25,"methodology":"case rate"}]}]},{"description":"AUGMENTATION LOWER JAW BONE","code_information":[{"code":"21125","type":"CPT"}],"standard_charges":[{"minimum":4336.27,"maximum":11624.04,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":5489,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":4645,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":11624.04,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":4336.27,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5986.38,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":5812.02,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5812.02,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":6102.62,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6044.5,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":5812.02,"methodology":"case rate"}]}]},{"description":"AUGMENTATION LOWER JAW BONE","code_information":[{"code":"21127","type":"CPT"}],"standard_charges":[{"minimum":4901,"maximum":11624.04,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":5792,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":4901,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":11624.04,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":5385.62,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5986.38,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":5812.02,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5812.02,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":6102.62,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6044.5,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":5812.02,"methodology":"case rate"}]}]},{"description":"REDUCTION OF FOREHEAD","code_information":[{"code":"21137","type":"CPT"}],"standard_charges":[{"minimum":3186.25,"maximum":6372.5,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":6372.5,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":3917.28,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3281.84,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":3186.25,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3186.25,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":3345.56,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3313.7,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":3186.25,"methodology":"case rate"}]}]},{"description":"REDUCTION OF FOREHEAD","code_information":[{"code":"21138","type":"CPT"}],"standard_charges":[{"minimum":3078.06,"maximum":11624.04,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":11624.04,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":3078.06,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5986.38,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":5812.02,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5812.02,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":6102.62,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6044.5,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":5812.02,"methodology":"case rate"}]}]},{"description":"REDUCTION OF FOREHEAD","code_information":[{"code":"21139","type":"CPT"}],"standard_charges":[{"minimum":3078.06,"maximum":11624.04,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":11624.04,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":3078.06,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5986.38,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":5812.02,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5812.02,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":6102.62,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6044.5,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":5812.02,"methodology":"case rate"}]}]},{"description":"LEFORT I-1 PIECE W/O GRAFT","code_information":[{"code":"21141","type":"CPT"}],"standard_charges":[{"minimum":1538.38,"maximum":11624.04,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":11624.04,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5986.38,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":5812.02,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5812.02,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":6102.62,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6044.5,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":5812.02,"methodology":"case rate"}]}]},{"description":"HC PALATAL EXPANSION","code_information":[{"code":"21142","type":"CPT"},{"code":"0360","type":"RC"}],"standard_charges":[{"minimum":1603.42,"maximum":1603.42,"gross_charge":1762,"discounted_cash":830.05,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1603.42,"methodology":"fee schedule"}]}]},{"description":"HC PALATAL EXPANSION","code_information":[{"code":"21142","type":"CPT"},{"code":"0360","type":"RC"}],"standard_charges":[{"minimum":413.9,"maximum":11624.04,"gross_charge":1762,"discounted_cash":830.05,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1110.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1110.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1110.06,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":11624.04,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1110.06,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":1110.06,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3917.28,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1603.42,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":845.76,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":1321.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":475.74,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":499.53,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":466.23,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":413.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":485.26,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":490.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5986.38,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":5812.02,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5812.02,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":6102.62,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6044.5,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":5812.02,"methodology":"case rate"}]}]},{"description":"LEFORT I-3/> PIECE W/O GRAFT","code_information":[{"code":"21143","type":"CPT"}],"standard_charges":[{"minimum":1923.63,"maximum":11624.04,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":11624.04,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1923.63,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5986.38,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":5812.02,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5812.02,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":6102.62,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6044.5,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":5812.02,"methodology":"case rate"}]}]},{"description":"LEFORT I-1 PIECE W/ GRAFT","code_information":[{"code":"21145","type":"CPT"}],"standard_charges":[{"minimum":1923.63,"maximum":1923.63,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"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|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1923.63,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"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":1923.63,"maximum":1923.63,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"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|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1923.63,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"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":1923.63,"maximum":1923.63,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"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|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1923.63,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"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":3078.06,"maximum":11624.04,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":11624.04,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":3078.06,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5986.38,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":5812.02,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5812.02,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":6102.62,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6044.5,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":5812.02,"methodology":"case rate"}]}]},{"description":"LEFORT II W/BONE GRAFTS","code_information":[{"code":"21151","type":"CPT"}],"standard_charges":[{"minimum":3497.02,"maximum":3497.02,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"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|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":3497.02,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"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":3497.02,"maximum":3497.02,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"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|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":3497.02,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"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":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"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|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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":52,"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":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"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":3497.02,"maximum":3497.02,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"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|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":3497.02,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"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":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"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|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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":52,"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":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"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":3078.06,"maximum":11624.04,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":11624.04,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":3078.06,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5986.38,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":5812.02,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5812.02,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":6102.62,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6044.5,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":5812.02,"methodology":"case rate"}]}]},{"description":"RECONSTRUCT ORBIT/FOREHEAD","code_information":[{"code":"21175","type":"CPT"}],"standard_charges":[{"minimum":3497.02,"maximum":11624.04,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":11624.04,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":3497.02,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5986.38,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":5812.02,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5812.02,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":6102.62,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6044.5,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":5812.02,"methodology":"case rate"}]}]},{"description":"RECONSTRUCT ENTIRE FOREHEAD","code_information":[{"code":"21179","type":"CPT"}],"standard_charges":[{"minimum":3497.02,"maximum":3497.02,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"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|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":3497.02,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"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":3497.02,"maximum":3497.02,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"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|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":3497.02,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"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":4336.27,"maximum":11624.04,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":5489,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":4645,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":11624.04,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":4336.27,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5986.38,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":5812.02,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5812.02,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":6102.62,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6044.5,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":5812.02,"methodology":"case rate"}]}]},{"description":"RECONSTRUCT CRANIAL BONE","code_information":[{"code":"21182","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"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|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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":52,"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":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"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":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"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|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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":52,"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":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"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":3497.02,"maximum":3497.02,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"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|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":3497.02,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"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":3078.06,"maximum":3078.06,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"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|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":3078.06,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"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":1538.38,"maximum":11624.04,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":11624.04,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5986.38,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":5812.02,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5812.02,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":6102.62,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6044.5,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":5812.02,"methodology":"case rate"}]}]},{"description":"RECONST LWR JAW W/GRAFT","code_information":[{"code":"21194","type":"CPT"}],"standard_charges":[{"minimum":1923.63,"maximum":11624.04,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":11624.04,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1923.63,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5986.38,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":5812.02,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5812.02,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":6102.62,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6044.5,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":5812.02,"methodology":"case rate"}]}]},{"description":"RECONST LWR JAW W/O FIXATION","code_information":[{"code":"21195","type":"CPT"}],"standard_charges":[{"minimum":1923.63,"maximum":11624.04,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":11624.04,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1923.63,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5986.38,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":5812.02,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5812.02,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":6102.62,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6044.5,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":5812.02,"methodology":"case rate"}]}]},{"description":"RECONST LWR JAW W/FIXATION","code_information":[{"code":"21196","type":"CPT"}],"standard_charges":[{"minimum":1923.63,"maximum":11624.04,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":11624.04,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1923.63,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5986.38,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":5812.02,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5812.02,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":6102.62,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6044.5,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":5812.02,"methodology":"case rate"}]}]},{"description":"RECONSTR LWR JAW SEGMENT","code_information":[{"code":"21198","type":"CPT"}],"standard_charges":[{"minimum":3497.02,"maximum":11624.04,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":11624.04,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":3497.02,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5986.38,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":5812.02,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5812.02,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":6102.62,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6044.5,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":5812.02,"methodology":"case rate"}]}]},{"description":"RECONSTR LWR JAW W/ADVANCE","code_information":[{"code":"21199","type":"CPT"}],"standard_charges":[{"minimum":3497.02,"maximum":11624.04,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":11624.04,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":3497.02,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5986.38,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":5812.02,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5812.02,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":6102.62,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6044.5,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":5812.02,"methodology":"case rate"}]}]},{"description":"CONCOMITANT AORTIC AND MITRAL VALVE PROCEDURES","code_information":[{"code":"212","type":"MS-DRG"}],"standard_charges":[{"minimum":65817.05,"maximum":164029,"setting":"inpatient","payers_information":[{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":164029,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":146675,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":153958,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":136332,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":161208,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":148702,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":65817.05,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":76786.56,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":73130.05,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":74592.66,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":74592.66,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":74592.66,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":79288.37,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":77363.9,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":76979,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":80827.95,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":78903.48,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":76979,"methodology":"case rate"}]}]},{"description":"RECONSTRUCT UPPER JAW BONE","code_information":[{"code":"21206","type":"CPT"}],"standard_charges":[{"minimum":3497.02,"maximum":11624.04,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":4514,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3819,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":11624.04,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":3497.02,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5986.38,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":5812.02,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5812.02,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":6102.62,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6044.5,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":5812.02,"methodology":"case rate"}]}]},{"description":"AUGMENTATION OF FACIAL BONES","code_information":[{"code":"21208","type":"CPT"}],"standard_charges":[{"minimum":4336.27,"maximum":11624.04,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":5489,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":4645,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":11624.04,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":4336.27,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5986.38,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":5812.02,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5812.02,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":6102.62,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6044.5,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":5812.02,"methodology":"case rate"}]}]},{"description":"REDUCTION OF FACIAL BONES","code_information":[{"code":"21209","type":"CPT"}],"standard_charges":[{"minimum":3497.02,"maximum":11624.04,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":4514,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3819,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":11624.04,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":3497.02,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5986.38,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":5812.02,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5812.02,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":6102.62,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6044.5,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":5812.02,"methodology":"case rate"}]}]},{"description":"FACE BONE GRAFT","code_information":[{"code":"21210","type":"CPT"}],"standard_charges":[{"minimum":4336.27,"maximum":11624.04,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":5489,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":4645,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":11624.04,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":4336.27,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5986.38,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":5812.02,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5812.02,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":6102.62,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6044.5,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":5812.02,"methodology":"case rate"}]}]},{"description":"LOWER JAW BONE GRAFT","code_information":[{"code":"21215","type":"CPT"}],"standard_charges":[{"minimum":4336.27,"maximum":11624.04,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":5489,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":4645,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":11624.04,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":4336.27,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5986.38,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":5812.02,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5812.02,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":6102.62,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6044.5,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":5812.02,"methodology":"case rate"}]}]},{"description":"RIB CARTILAGE GRAFT","code_information":[{"code":"21230","type":"CPT"}],"standard_charges":[{"minimum":4336.27,"maximum":11624.04,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":5489,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":4645,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":11624.04,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":4336.27,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5986.38,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":5812.02,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5812.02,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":6102.62,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6044.5,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":5812.02,"methodology":"case rate"}]}]},{"description":"EAR CARTILAGE GRAFT","code_information":[{"code":"21235","type":"CPT"}],"standard_charges":[{"minimum":4336.27,"maximum":11624.04,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":5489,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":4645,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":11624.04,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":4336.27,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5986.38,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":5812.02,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5812.02,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":6102.62,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6044.5,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":5812.02,"methodology":"case rate"}]}]},{"description":"RECONSTRUCTION OF JAW JOINT","code_information":[{"code":"21240","type":"CPT"}],"standard_charges":[{"minimum":3078.06,"maximum":11624.04,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":4157,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3517,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":11624.04,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":3078.06,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5986.38,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":5812.02,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5812.02,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":6102.62,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6044.5,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":5812.02,"methodology":"case rate"}]}]},{"description":"RECONSTRUCTION OF JAW JOINT","code_information":[{"code":"21242","type":"CPT"}],"standard_charges":[{"minimum":3497.02,"maximum":11624.04,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":4514,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3819,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":11624.04,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":3497.02,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5986.38,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":5812.02,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5812.02,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":6102.62,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6044.5,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":5812.02,"methodology":"case rate"}]}]},{"description":"RECONSTRUCTION OF JAW JOINT","code_information":[{"code":"21243","type":"CPT"}],"standard_charges":[{"minimum":3497.02,"maximum":36135.72,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":4514,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3819,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":36135.72,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":3497.02,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":18609.9,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":18067.86,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":18067.86,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":18971.25,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":18790.57,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":18067.86,"methodology":"case rate"}]}]},{"description":"RECONSTRUCTION OF LOWER JAW","code_information":[{"code":"21244","type":"CPT"}],"standard_charges":[{"minimum":4336.27,"maximum":11624.04,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":5489,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":4645,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":11624.04,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":4336.27,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5986.38,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":5812.02,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5812.02,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":6102.62,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6044.5,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":5812.02,"methodology":"case rate"}]}]},{"description":"RECONSTRUCTION OF JAW","code_information":[{"code":"21245","type":"CPT"}],"standard_charges":[{"minimum":4336.27,"maximum":11624.04,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":5489,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":4645,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":11624.04,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":4336.27,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5986.38,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":5812.02,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5812.02,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":6102.62,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6044.5,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":5812.02,"methodology":"case rate"}]}]},{"description":"RECONSTRUCTION OF JAW","code_information":[{"code":"21246","type":"CPT"}],"standard_charges":[{"minimum":4336.27,"maximum":11624.04,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":5489,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":4645,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":11624.04,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":4336.27,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5986.38,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":5812.02,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5812.02,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":6102.62,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6044.5,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":5812.02,"methodology":"case rate"}]}]},{"description":"RECONSTRUCT LOWER JAW BONE","code_information":[{"code":"21247","type":"CPT"}],"standard_charges":[{"minimum":3497.02,"maximum":3497.02,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"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|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":3497.02,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"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":4336.27,"maximum":11624.04,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":5489,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":4645,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":11624.04,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":4336.27,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5986.38,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":5812.02,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5812.02,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":6102.62,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6044.5,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":5812.02,"methodology":"case rate"}]}]},{"description":"RECONSTRUCTION OF JAW","code_information":[{"code":"21249","type":"CPT"}],"standard_charges":[{"minimum":4336.27,"maximum":11624.04,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":5489,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":4645,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":11624.04,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":4336.27,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5986.38,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":5812.02,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5812.02,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":6102.62,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6044.5,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":5812.02,"methodology":"case rate"}]}]},{"description":"RECONSTRUCT LOWER JAW BONE","code_information":[{"code":"21255","type":"CPT"}],"standard_charges":[{"minimum":3917.28,"maximum":11624.04,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":11624.04,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":3917.28,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5986.38,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":5812.02,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5812.02,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":6102.62,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6044.5,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":5812.02,"methodology":"case rate"}]}]},{"description":"RECONSTRUCTION OF ORBIT","code_information":[{"code":"21256","type":"CPT"}],"standard_charges":[{"minimum":3917.28,"maximum":11624.04,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":11624.04,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":3917.28,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5986.38,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":5812.02,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5812.02,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":6102.62,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6044.5,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":5812.02,"methodology":"case rate"}]}]},{"description":"REVISE EYE SOCKETS","code_information":[{"code":"21260","type":"CPT"}],"standard_charges":[{"minimum":3497.02,"maximum":11624.04,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":11624.04,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":3497.02,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5986.38,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":5812.02,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5812.02,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":6102.62,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6044.5,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":5812.02,"methodology":"case rate"}]}]},{"description":"REVISE EYE SOCKETS","code_information":[{"code":"21261","type":"CPT"}],"standard_charges":[{"minimum":3497.02,"maximum":11624.04,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":11624.04,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":3497.02,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5986.38,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":5812.02,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5812.02,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":6102.62,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6044.5,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":5812.02,"methodology":"case rate"}]}]},{"description":"REVISE EYE SOCKETS","code_information":[{"code":"21263","type":"CPT"}],"standard_charges":[{"minimum":3497.02,"maximum":11624.04,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":11624.04,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":3497.02,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5986.38,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":5812.02,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5812.02,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":6102.62,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6044.5,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":5812.02,"methodology":"case rate"}]}]},{"description":"REVISE EYE SOCKETS","code_information":[{"code":"21267","type":"CPT"}],"standard_charges":[{"minimum":4336.27,"maximum":11624.04,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":5489,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":4645,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":11624.04,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":4336.27,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5986.38,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":5812.02,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5812.02,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":6102.62,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6044.5,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":5812.02,"methodology":"case rate"}]}]},{"description":"REVISE EYE SOCKETS","code_information":[{"code":"21268","type":"CPT"}],"standard_charges":[{"minimum":3078.06,"maximum":3078.06,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"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|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":3078.06,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"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":3497.02,"maximum":11624.04,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":4514,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3819,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":11624.04,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":3497.02,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5986.38,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":5812.02,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5812.02,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":6102.62,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6044.5,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":5812.02,"methodology":"case rate"}]}]},{"description":"REVISION ORBITOFACIAL BONES","code_information":[{"code":"21275","type":"CPT"}],"standard_charges":[{"minimum":4336.27,"maximum":11624.04,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":5489,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":4645,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":11624.04,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":4336.27,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5986.38,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":5812.02,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5812.02,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":6102.62,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6044.5,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":5812.02,"methodology":"case rate"}]}]},{"description":"REVISION OF EYELID","code_information":[{"code":"21280","type":"CPT"}],"standard_charges":[{"minimum":3186.25,"maximum":6372.5,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":4514,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3819,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":6372.5,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":3497.02,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3281.84,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":3186.25,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3186.25,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":3345.56,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3313.7,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":3186.25,"methodology":"case rate"}]}]},{"description":"REVISION OF EYELID","code_information":[{"code":"21282","type":"CPT"}],"standard_charges":[{"minimum":3186.25,"maximum":6372.5,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":4514,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3819,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":6372.5,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":3497.02,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3281.84,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":3186.25,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3186.25,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":3345.56,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3313.7,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":3186.25,"methodology":"case rate"}]}]},{"description":"REVISION OF JAW MUSCLE/BONE","code_information":[{"code":"21295","type":"CPT"}],"standard_charges":[{"minimum":1455.33,"maximum":2910.66,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2152,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":1821,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":2910.66,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1498.99,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":1455.33,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1455.33,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":1528.1,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1513.54,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":1455.33,"methodology":"case rate"}]}]},{"description":"REVISION OF JAW MUSCLE/BONE","code_information":[{"code":"21296","type":"CPT"}],"standard_charges":[{"minimum":1538.38,"maximum":6372.5,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2152,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":1821,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":6372.5,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3281.84,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":3186.25,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3186.25,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":3345.56,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3313.7,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":3186.25,"methodology":"case rate"}]}]},{"description":"CRANIO/MAXILLOFACIAL SURGERY","code_information":[{"code":"21299","type":"CPT"}],"standard_charges":[{"minimum":228.15,"maximum":1538.38,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":456.3,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":234.99,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":228.15,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":228.15,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":239.56,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":237.28,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":228.15,"methodology":"case rate"}]}]},{"description":"CLOSED TX NOSE FX W/O MANJ","code_information":[{"code":"21310","type":"CPT"}],"standard_charges":[{"minimum":2011,"maximum":2376,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2376,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":2011,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC CL TX NASAL FX WO STBLZ","code_information":[{"code":"21315","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":179.27,"maximum":179.27,"gross_charge":197,"discounted_cash":92.81,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":179.27,"methodology":"fee schedule"}]}]},{"description":"HC CL TX NASAL FX WO STBLZ","code_information":[{"code":"21315","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":46.28,"maximum":2910.66,"gross_charge":197,"discounted_cash":92.81,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":124.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":124.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":124.11,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2376,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":2011,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":2910.66,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":124.11,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":124.11,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1923.63,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":179.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":94.56,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":147.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":53.19,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":55.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":52.13,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":46.28,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":54.26,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":54.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1498.99,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":1455.33,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1455.33,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":1528.1,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1513.54,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":1455.33,"methodology":"case rate"}]}]},{"description":"HC CL TX NASAL FX W STBLZ","code_information":[{"code":"21320","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":320.32,"maximum":320.32,"gross_charge":352,"discounted_cash":165.83,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":320.32,"methodology":"fee schedule"}]}]},{"description":"HC CL TX NASAL FX W STBLZ","code_information":[{"code":"21320","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":82.69,"maximum":6372.5,"gross_charge":352,"discounted_cash":165.83,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":221.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":221.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":221.76,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2376,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":2011,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":6372.5,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":221.76,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":221.76,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1923.63,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":320.32,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":168.96,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":264,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":95.04,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":99.8,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":93.14,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":82.69,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":96.95,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":97.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3281.84,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":3186.25,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3186.25,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":3345.56,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3313.7,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":3186.25,"methodology":"case rate"}]}]},{"description":"OPEN TX NOSE FX UNCOMPLICATD","code_information":[{"code":"21325","type":"CPT"}],"standard_charges":[{"minimum":3078.06,"maximum":6372.5,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":4157,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3517,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":6372.5,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":3078.06,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3281.84,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":3186.25,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3186.25,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":3345.56,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3313.7,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":3186.25,"methodology":"case rate"}]}]},{"description":"OPEN TX NOSE FX W/SKELE FIXJ","code_information":[{"code":"21330","type":"CPT"}],"standard_charges":[{"minimum":3497.02,"maximum":11624.04,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":4514,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3819,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":11624.04,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":3497.02,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5986.38,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":5812.02,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5812.02,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":6102.62,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6044.5,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":5812.02,"methodology":"case rate"}]}]},{"description":"OPEN TX NOSE  SEPTAL FX","code_information":[{"code":"21335","type":"CPT"}],"standard_charges":[{"minimum":3186.25,"maximum":6372.5,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":5489,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":4645,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":6372.5,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":4336.27,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3281.84,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":3186.25,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3186.25,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":3345.56,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3313.7,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":3186.25,"methodology":"case rate"}]}]},{"description":"HC TREAT NASAL SEPTAL FRACTURE","code_information":[{"code":"21336","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":4488.12,"maximum":4488.12,"gross_charge":4932,"discounted_cash":2323.39,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4488.12,"methodology":"fee schedule"}]}]},{"description":"HC TREAT NASAL SEPTAL FRACTURE","code_information":[{"code":"21336","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":1158.53,"maximum":6375.52,"gross_charge":4932,"discounted_cash":2323.39,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3107.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3107.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3107.16,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":4157,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3517,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":6375.52,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3107.16,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3107.16,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3078.06,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4488.12,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2367.36,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":3699,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":1331.64,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":1398.23,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":1305.01,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":1158.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1358.28,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1371.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3283.39,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":3187.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3187.76,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":3347.15,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3315.27,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":3187.76,"methodology":"case rate"}]}]},{"description":"HC CLOSED RX NASAL SEPTAL FRACTURE","code_information":[{"code":"21337","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":4488.12,"maximum":4488.12,"gross_charge":4932,"discounted_cash":2323.39,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4488.12,"methodology":"fee schedule"}]}]},{"description":"HC CLOSED RX NASAL SEPTAL FRACTURE","code_information":[{"code":"21337","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":1158.53,"maximum":6372.5,"gross_charge":4932,"discounted_cash":2323.39,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3107.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3107.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3107.16,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2376,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":2011,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":6372.5,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3107.16,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3107.16,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1923.63,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4488.12,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2367.36,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":3699,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":1331.64,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":1398.23,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":1305.01,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":1158.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1358.28,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1371.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3281.84,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":3186.25,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3186.25,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":3345.56,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3313.7,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":3186.25,"methodology":"case rate"}]}]},{"description":"OPEN NASOETHMOID FX W/O FIXJ","code_information":[{"code":"21338","type":"CPT"}],"standard_charges":[{"minimum":3078.06,"maximum":11624.04,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":4157,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3517,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":11624.04,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":3078.06,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5986.38,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":5812.02,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5812.02,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":6102.62,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6044.5,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":5812.02,"methodology":"case rate"}]}]},{"description":"OPEN NASOETHMOID FX W/ FIXJ","code_information":[{"code":"21339","type":"CPT"}],"standard_charges":[{"minimum":3497.02,"maximum":11624.04,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":4514,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3819,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":11624.04,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":3497.02,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5986.38,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":5812.02,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5812.02,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":6102.62,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6044.5,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":5812.02,"methodology":"case rate"}]}]},{"description":"PERQ TX NASOETHMOID FX","code_information":[{"code":"21340","type":"CPT"}],"standard_charges":[{"minimum":3078.06,"maximum":6372.5,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":4157,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3517,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":6372.5,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":3078.06,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3281.84,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":3186.25,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3186.25,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":3345.56,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3313.7,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":3186.25,"methodology":"case rate"}]}]},{"description":"OPEN TX DPRSD FRONT SINUS FX","code_information":[{"code":"21343","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"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|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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":52,"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":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"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":3917.28,"maximum":3917.28,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"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|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":3917.28,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"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":1455.33,"maximum":5489,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":5489,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":4645,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":2910.66,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":4336.27,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1498.99,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":1455.33,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1455.33,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":1528.1,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1513.54,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":1455.33,"methodology":"case rate"}]}]},{"description":"OPN TX NASOMAX FX W/FIXJ","code_information":[{"code":"21346","type":"CPT"}],"standard_charges":[{"minimum":1538.38,"maximum":11624.04,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":11624.04,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5986.38,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":5812.02,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5812.02,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":6102.62,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6044.5,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":5812.02,"methodology":"case rate"}]}]},{"description":"OPN TX NASOMAX FX MULTPLE","code_information":[{"code":"21347","type":"CPT"}],"standard_charges":[{"minimum":1538.38,"maximum":11624.04,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":11624.04,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5986.38,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":5812.02,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5812.02,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":6102.62,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6044.5,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":5812.02,"methodology":"case rate"}]}]},{"description":"OPN TX NASOMAX FX W/GRAFT","code_information":[{"code":"21348","type":"CPT"}],"standard_charges":[{"minimum":1923.63,"maximum":1923.63,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"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|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1923.63,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"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":2657.78,"maximum":6372.5,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":3796,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3212,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":6372.5,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":2657.78,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3281.84,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":3186.25,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3186.25,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":3345.56,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3313.7,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":3186.25,"methodology":"case rate"}]}]},{"description":"OPN TX DPRSD ZYGOMATIC ARCH","code_information":[{"code":"21356","type":"CPT"}],"standard_charges":[{"minimum":2657.78,"maximum":11624.04,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":3796,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3212,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":11624.04,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":2657.78,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5986.38,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":5812.02,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5812.02,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":6102.62,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6044.5,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":5812.02,"methodology":"case rate"}]}]},{"description":"OPN TX DPRSD MALAR FRACTURE","code_information":[{"code":"21360","type":"CPT"}],"standard_charges":[{"minimum":4266.22,"maximum":11624.04,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":11624.04,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":4266.22,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5986.38,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":5812.02,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5812.02,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":6102.62,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6044.5,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":5812.02,"methodology":"case rate"}]}]},{"description":"OPN TX COMPLX MALAR FX","code_information":[{"code":"21365","type":"CPT"}],"standard_charges":[{"minimum":4266.22,"maximum":11624.04,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":11624.04,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":4266.22,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5986.38,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":5812.02,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5812.02,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":6102.62,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6044.5,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":5812.02,"methodology":"case rate"}]}]},{"description":"OPN TX COMPLX MALAR W/GRFT","code_information":[{"code":"21366","type":"CPT"}],"standard_charges":[{"minimum":3917.28,"maximum":11624.04,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":11624.04,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":3917.28,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5986.38,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":5812.02,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5812.02,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":6102.62,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6044.5,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":5812.02,"methodology":"case rate"}]}]},{"description":"OPN TX ORBIT FX TRANSANTRAL","code_information":[{"code":"21385","type":"CPT"}],"standard_charges":[{"minimum":4266.22,"maximum":11624.04,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":11624.04,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":4266.22,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5986.38,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":5812.02,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5812.02,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":6102.62,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6044.5,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":5812.02,"methodology":"case rate"}]}]},{"description":"OPN TX ORBIT FX PERIORBITAL","code_information":[{"code":"21386","type":"CPT"}],"standard_charges":[{"minimum":4266.22,"maximum":11624.04,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":11624.04,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":4266.22,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5986.38,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":5812.02,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5812.02,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":6102.62,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6044.5,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":5812.02,"methodology":"case rate"}]}]},{"description":"OPN TX ORBIT FX COMBINED","code_information":[{"code":"21387","type":"CPT"}],"standard_charges":[{"minimum":4266.22,"maximum":11624.04,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":11624.04,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":4266.22,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5986.38,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":5812.02,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5812.02,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":6102.62,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6044.5,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":5812.02,"methodology":"case rate"}]}]},{"description":"OPN TX ORBIT PERIORBTL IMPLT","code_information":[{"code":"21390","type":"CPT"}],"standard_charges":[{"minimum":4266.22,"maximum":11624.04,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":11624.04,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":4266.22,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5986.38,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":5812.02,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5812.02,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":6102.62,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6044.5,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":5812.02,"methodology":"case rate"}]}]},{"description":"OPN TX ORBIT PERIORBT W/GRFT","code_information":[{"code":"21395","type":"CPT"}],"standard_charges":[{"minimum":4266.22,"maximum":11624.04,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":11624.04,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":4266.22,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5986.38,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":5812.02,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5812.02,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":6102.62,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6044.5,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":5812.02,"methodology":"case rate"}]}]},{"description":"HC CLOSED RX FX ORBIT","code_information":[{"code":"21400","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":1984.71,"maximum":1984.71,"gross_charge":2181,"discounted_cash":1027.44,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1984.71,"methodology":"fee schedule"}]}]},{"description":"HC CLOSED RX FX ORBIT","code_information":[{"code":"21400","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":500.33,"maximum":2376,"gross_charge":2181,"discounted_cash":1027.44,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1374.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1374.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1374.03,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2376,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":2011,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":1000.66,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1374.03,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":1374.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1923.63,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1984.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1046.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":1635.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":588.87,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":618.32,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":577.1,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":512.32,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":600.65,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":606.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":515.34,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":500.33,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":500.33,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":525.35,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":520.34,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":500.33,"methodology":"case rate"}]}]},{"description":"HC CLOSED RX FX ORBIT W MANIPULATN","code_information":[{"code":"21401","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":1984.71,"maximum":1984.71,"gross_charge":2181,"discounted_cash":1027.44,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1984.71,"methodology":"fee schedule"}]}]},{"description":"HC CLOSED RX FX ORBIT W MANIPULATN","code_information":[{"code":"21401","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":512.32,"maximum":3796,"gross_charge":2181,"discounted_cash":1027.44,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1374.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1374.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1374.03,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":3796,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3212,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":2910.66,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1374.03,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":1374.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2657.78,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1984.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1046.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":1635.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":588.87,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":618.32,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":577.1,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":512.32,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":600.65,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":606.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1498.99,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":1455.33,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1455.33,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":1528.1,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1513.54,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":1455.33,"methodology":"case rate"}]}]},{"description":"OPN TX ORBIT FX W/O IMPLANT","code_information":[{"code":"21406","type":"CPT"}],"standard_charges":[{"minimum":4266.22,"maximum":11624.04,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":11624.04,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":4266.22,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5986.38,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":5812.02,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5812.02,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":6102.62,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6044.5,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":5812.02,"methodology":"case rate"}]}]},{"description":"OPN TX ORBIT FX W/IMPLANT","code_information":[{"code":"21407","type":"CPT"}],"standard_charges":[{"minimum":3517,"maximum":11624.04,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":4157,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3517,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":11624.04,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":4266.22,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5986.38,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":5812.02,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5812.02,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":6102.62,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6044.5,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":5812.02,"methodology":"case rate"}]}]},{"description":"OPN TX ORBIT FX W/BONE GRFT","code_information":[{"code":"21408","type":"CPT"}],"standard_charges":[{"minimum":1538.38,"maximum":11624.04,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":11624.04,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5986.38,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":5812.02,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5812.02,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":6102.62,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6044.5,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":5812.02,"methodology":"case rate"}]}]},{"description":"TREAT MOUTH ROOF FRACTURE","code_information":[{"code":"21421","type":"CPT"}],"standard_charges":[{"minimum":3078.06,"maximum":6372.5,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":4157,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3517,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":6372.5,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":3078.06,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3281.84,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":3186.25,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3186.25,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":3345.56,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3313.7,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":3186.25,"methodology":"case rate"}]}]},{"description":"TREAT MOUTH ROOF FRACTURE","code_information":[{"code":"21422","type":"CPT"}],"standard_charges":[{"minimum":5812.02,"maximum":11624.04,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":11624.04,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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":52,"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":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5986.38,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":5812.02,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5812.02,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":6102.62,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6044.5,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":5812.02,"methodology":"case rate"}]}]},{"description":"TREAT MOUTH ROOF FRACTURE","code_information":[{"code":"21423","type":"CPT"}],"standard_charges":[{"minimum":1538.38,"maximum":1538.38,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"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|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"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":1538.38,"maximum":1538.38,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"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|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"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":1538.38,"maximum":1538.38,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"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|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"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":3078.06,"maximum":3078.06,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"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|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":3078.06,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"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":1923.63,"maximum":1923.63,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"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|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1923.63,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"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":3078.06,"maximum":3078.06,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"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|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":3078.06,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC CLOSED RX DENTAL RIDGE FX","code_information":[{"code":"21440","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":3081.26,"maximum":3081.26,"gross_charge":3386,"discounted_cash":1595.09,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3081.26,"methodology":"fee schedule"}]}]},{"description":"HC CLOSED RX DENTAL RIDGE FX","code_information":[{"code":"21440","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":795.38,"maximum":6372.5,"gross_charge":3386,"discounted_cash":1595.09,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2133.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2133.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2133.18,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":3796,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3212,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":6372.5,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2133.18,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2133.18,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1923.63,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3081.26,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1625.28,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":2539.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":914.22,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":959.94,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":895.94,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":795.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":932.51,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":941.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3281.84,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":3186.25,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3186.25,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":3345.56,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3313.7,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":3186.25,"methodology":"case rate"}]}]},{"description":"TREAT DENTAL RIDGE FRACTURE","code_information":[{"code":"21445","type":"CPT"}],"standard_charges":[{"minimum":3078.06,"maximum":11624.04,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":4157,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3517,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":11624.04,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":3078.06,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5986.38,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":5812.02,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5812.02,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":6102.62,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6044.5,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":5812.02,"methodology":"case rate"}]}]},{"description":"HC TX OF LOWER JAW FRACTURE","code_information":[{"code":"21450","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":970.06,"maximum":970.06,"gross_charge":1066,"discounted_cash":502.18,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":970.06,"methodology":"fee schedule"}]}]},{"description":"HC TX OF LOWER JAW FRACTURE","code_information":[{"code":"21450","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":250.41,"maximum":3796,"gross_charge":1066,"discounted_cash":502.18,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":671.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":671.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":671.58,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":3796,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3212,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":1000.66,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":671.58,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":671.58,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2657.78,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":970.06,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":511.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":799.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":287.82,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":302.22,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":282.07,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":250.41,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":293.58,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":296.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":515.34,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":500.33,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":500.33,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":525.35,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":520.34,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":500.33,"methodology":"case rate"}]}]},{"description":"HC CLOSED RX MANDIBLE FX+MANIPULATN","code_information":[{"code":"21451","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":2308.67,"maximum":2308.67,"gross_charge":2537,"discounted_cash":1195.14,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2308.67,"methodology":"fee schedule"}]}]},{"description":"HC CLOSED RX MANDIBLE FX+MANIPULATN","code_information":[{"code":"21451","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":595.95,"maximum":4157,"gross_charge":2537,"discounted_cash":1195.14,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1598.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1598.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1598.31,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":4157,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3517,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":2910.66,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1598.31,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":1598.31,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3078.06,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2308.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1217.76,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":1902.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":684.99,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":719.24,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":671.3,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":595.95,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":698.69,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":705.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1498.99,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":1455.33,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1455.33,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":1528.1,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1513.54,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":1455.33,"methodology":"case rate"}]}]},{"description":"TREAT LOWER JAW FRACTURE","code_information":[{"code":"21452","type":"CPT"}],"standard_charges":[{"minimum":1923.63,"maximum":11624.04,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2376,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":2011,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":11624.04,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1923.63,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5986.38,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":5812.02,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5812.02,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":6102.62,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6044.5,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":5812.02,"methodology":"case rate"}]}]},{"description":"HC TREAT LOWER JAW FRACTURE","code_information":[{"code":"21453","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":3903.9,"maximum":3903.9,"gross_charge":4290,"discounted_cash":2020.95,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3903.9,"methodology":"fee schedule"}]}]},{"description":"HC TREAT LOWER JAW FRACTURE","code_information":[{"code":"21453","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":1007.73,"maximum":11624.04,"gross_charge":4290,"discounted_cash":2020.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2702.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2702.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2702.7,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":3796,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3212,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":11624.04,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2702.7,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2702.7,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2657.78,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3903.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2059.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":3217.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":1158.3,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":1216.22,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":1135.14,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":1007.73,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1181.47,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1193.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5986.38,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":5812.02,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5812.02,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":6102.62,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6044.5,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":5812.02,"methodology":"case rate"}]}]},{"description":"TREAT LOWER JAW FRACTURE","code_information":[{"code":"21454","type":"CPT"}],"standard_charges":[{"minimum":3497.02,"maximum":11624.04,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":4514,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3819,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":11624.04,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":3497.02,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5986.38,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":5812.02,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5812.02,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":6102.62,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6044.5,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":5812.02,"methodology":"case rate"}]}]},{"description":"TREAT LOWER JAW FRACTURE","code_information":[{"code":"21461","type":"CPT"}],"standard_charges":[{"minimum":3078.06,"maximum":11624.04,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":4157,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3517,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":11624.04,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":3078.06,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5986.38,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":5812.02,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5812.02,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":6102.62,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6044.5,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":5812.02,"methodology":"case rate"}]}]},{"description":"TREAT LOWER JAW FRACTURE","code_information":[{"code":"21462","type":"CPT"}],"standard_charges":[{"minimum":3497.02,"maximum":11624.04,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":4514,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3819,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":11624.04,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":3497.02,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5986.38,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":5812.02,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5812.02,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":6102.62,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6044.5,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":5812.02,"methodology":"case rate"}]}]},{"description":"TREAT LOWER JAW FRACTURE","code_information":[{"code":"21465","type":"CPT"}],"standard_charges":[{"minimum":3078.06,"maximum":11624.04,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":4157,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3517,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":11624.04,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":3078.06,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5986.38,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":5812.02,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5812.02,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":6102.62,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6044.5,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":5812.02,"methodology":"case rate"}]}]},{"description":"TREAT LOWER JAW FRACTURE","code_information":[{"code":"21470","type":"CPT"}],"standard_charges":[{"minimum":4266.22,"maximum":11624.04,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":11624.04,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":4266.22,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5986.38,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":5812.02,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5812.02,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":6102.62,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6044.5,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":5812.02,"methodology":"case rate"}]}]},{"description":"HC CL TX TM JOINT DISLOCATION","code_information":[{"code":"21480","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":524.16,"maximum":524.16,"gross_charge":576,"discounted_cash":271.35,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":524.16,"methodology":"fee schedule"}]}]},{"description":"HC CL TX TM JOINT DISLOCATION","code_information":[{"code":"21480","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":135.31,"maximum":2152,"gross_charge":576,"discounted_cash":271.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":362.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":362.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":362.88,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2152,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":1821,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":471.36,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":362.88,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":362.88,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":524.16,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":276.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":432,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":155.52,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":163.3,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":152.41,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":135.31,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":158.64,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":160.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":242.75,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":235.68,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":235.68,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":247.46,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":245.11,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":235.68,"methodology":"case rate"}]}]},{"description":"HC CLOSED TX OF JAW TMJ DISLOCATION","code_information":[{"code":"21485","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":3687.32,"maximum":3687.32,"gross_charge":4052,"discounted_cash":1908.83,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3687.32,"methodology":"fee schedule"}]}]},{"description":"HC CLOSED TX OF JAW TMJ DISLOCATION","code_information":[{"code":"21485","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":951.82,"maximum":3687.32,"gross_charge":4052,"discounted_cash":1908.83,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2552.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2552.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2552.76,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2376,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":2011,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":2910.66,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2552.76,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2552.76,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1923.63,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3687.32,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1944.96,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":3039,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":1094.04,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":1148.75,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":1072.16,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":951.82,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1115.93,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1126.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1498.99,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":1455.33,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1455.33,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":1528.1,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1513.54,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":1455.33,"methodology":"case rate"}]}]},{"description":"REPAIR DISLOCATED JAW","code_information":[{"code":"21490","type":"CPT"}],"standard_charges":[{"minimum":2657.78,"maximum":6372.5,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":3796,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3212,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":6372.5,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":2657.78,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3281.84,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":3186.25,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3186.25,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":3345.56,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3313.7,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":3186.25,"methodology":"case rate"}]}]},{"description":"INTERDENTAL WIRING","code_information":[{"code":"21497","type":"CPT"}],"standard_charges":[{"minimum":1455.33,"maximum":2910.66,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2376,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":2011,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":2910.66,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1923.63,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1498.99,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":1455.33,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1455.33,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":1528.1,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1513.54,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":1455.33,"methodology":"case rate"}]}]},{"description":"HEAD SURGERY PROCEDURE","code_information":[{"code":"21499","type":"CPT"}],"standard_charges":[{"minimum":228.15,"maximum":1538.38,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":456.3,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":234.99,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":228.15,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":228.15,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":239.56,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":237.28,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":228.15,"methodology":"case rate"}]}]},{"description":"OTHER HEART ASSIST SYSTEM IMPLANT","code_information":[{"code":"215","type":"MS-DRG"}],"standard_charges":[{"minimum":64018.05,"maximum":159526,"setting":"inpatient","payers_information":[{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":159526,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":142648,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":149749.8,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":132589,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":156782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":144619,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":64018.05,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":74687.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":71131.16,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":72553.79,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":72553.79,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":72553.79,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":77121.15,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":75249.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":74874.9,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":78618.65,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":76746.78,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":74874.9,"methodology":"case rate"}]}]},{"description":"DRAIN NECK/CHEST LESION","code_information":[{"code":"21501","type":"CPT"}],"standard_charges":[{"minimum":1923.63,"maximum":5623.82,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2376,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":2011,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":5623.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1923.63,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2896.27,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":2811.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2811.91,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":2952.51,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2924.39,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":2811.91,"methodology":"case rate"}]}]},{"description":"DRAIN CHEST LESION","code_information":[{"code":"21502","type":"CPT"}],"standard_charges":[{"minimum":1923.63,"maximum":6375.52,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2376,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":2011,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":6375.52,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1923.63,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3283.39,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":3187.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3187.76,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":3347.15,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3315.27,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":3187.76,"methodology":"case rate"}]}]},{"description":"DRAINAGE OF BONE LESION","code_information":[{"code":"21510","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"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|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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":52,"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":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC BIOPSY SOFT TISSUE NECK/CHEST","code_information":[{"code":"21550","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":3621.8,"maximum":3621.8,"gross_charge":3980,"discounted_cash":1874.92,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3621.8,"methodology":"fee schedule"}]}]},{"description":"HC BIOPSY SOFT TISSUE NECK/CHEST","code_information":[{"code":"21550","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":934.91,"maximum":3621.8,"gross_charge":3980,"discounted_cash":1874.92,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2507.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2507.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2507.4,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":3183.7,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2507.4,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2507.4,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3621.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1910.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":2985,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":1074.6,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":1128.33,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":1053.11,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":934.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1096.1,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1106.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1639.61,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":1591.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1591.85,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":1671.44,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1655.52,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":1591.85,"methodology":"case rate"}]}]},{"description":"EXC NECK LES SC 3 CM/>","code_information":[{"code":"21552","type":"CPT"}],"standard_charges":[{"minimum":1538.38,"maximum":5623.82,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2376,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":2011,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":5623.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"median_amount":2562.83,"10th_percentile":2562.83,"90th_percentile":2562.83,"count":"1 through 10","methodology":"percent of total billed charges"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2896.27,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":2811.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2811.91,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":2952.51,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2924.39,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":2811.91,"methodology":"case rate"}]}]},{"description":"EXC NECK TUM DEEP 5 CM/>","code_information":[{"code":"21554","type":"CPT"}],"standard_charges":[{"minimum":1538.38,"maximum":5623.82,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2376,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":2011,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":5623.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_percentage":48,"median_amount":2484.4,"10th_percentile":2484.4,"90th_percentile":2484.4,"count":"1 through 10","methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2896.27,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":2811.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2811.91,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":2952.51,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2924.39,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":2811.91,"methodology":"case rate"}]}]},{"description":"EXC NECK LES SC < 3 CM","code_information":[{"code":"21555","type":"CPT"}],"standard_charges":[{"minimum":1591.85,"maximum":3183.7,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2376,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":2011,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":3183.7,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1923.63,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1639.61,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":1591.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1591.85,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":1671.44,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1655.52,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":1591.85,"methodology":"case rate"}]}]},{"description":"EXC NECK TUM DEEP < 5 CM","code_information":[{"code":"21556","type":"CPT"}],"standard_charges":[{"minimum":1923.63,"maximum":5623.82,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2376,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":2011,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":5623.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1923.63,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2896.27,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":2811.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2811.91,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":2952.51,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2924.39,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":2811.91,"methodology":"case rate"}]}]},{"description":"RESECT NECK THORAX TUMOR<5CM","code_information":[{"code":"21557","type":"CPT"}],"standard_charges":[{"minimum":1538.38,"maximum":5623.82,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":5623.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2896.27,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":2811.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2811.91,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":2952.51,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2924.39,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":2811.91,"methodology":"case rate"}]}]},{"description":"RESECT NECK TUMOR 5 CM/>","code_information":[{"code":"21558","type":"CPT"}],"standard_charges":[{"minimum":1538.38,"maximum":5623.82,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":5623.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2896.27,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":2811.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2811.91,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":2952.51,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2924.39,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":2811.91,"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":50221,"maximum":151966,"setting":"inpatient","payers_information":[{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":145317,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":151966,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":136472.34,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":50221,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":50221,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":120779,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":142817,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":131738,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":58341.94,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":68065.59,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":64824.37,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":66120.86,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":66120.86,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":66120.86,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":70283.26,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":68577.36,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":68236.17,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":71647.98,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":69942.08,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":68236.17,"methodology":"case rate"}]}]},{"description":"PARTIAL REMOVAL OF RIB","code_information":[{"code":"21600","type":"CPT"}],"standard_charges":[{"minimum":1923.63,"maximum":14037.14,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2376,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":2011,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":14037.14,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1923.63,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":7229.13,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":7369.5,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7299.31,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"}]}]},{"description":"EXC CHEST WALL TUMOR W/RIBS","code_information":[{"code":"21601","type":"CPT"}],"standard_charges":[{"minimum":2011,"maximum":5623.82,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2376,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":2011,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":5623.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":2657.78,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2896.27,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":2811.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2811.91,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":2952.51,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2924.39,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":2811.91,"methodology":"case rate"}]}]},{"description":"EXC CH WAL TUM W/O LYMPHADEC","code_information":[{"code":"21602","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"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|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"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":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"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|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"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":1923.63,"maximum":6375.52,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2376,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":2011,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":6375.52,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1923.63,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3283.39,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":3187.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3187.76,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":3347.15,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3315.27,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":3187.76,"methodology":"case rate"}]}]},{"description":"REMOVAL OF RIB","code_information":[{"code":"21615","type":"CPT"}],"standard_charges":[{"minimum":1538.38,"maximum":1538.38,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"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|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"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":1538.38,"maximum":1538.38,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"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|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"PARTIAL REMOVAL OF STERNUM","code_information":[{"code":"21620","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"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|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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":52,"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":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"STERNAL DEBRIDEMENT","code_information":[{"code":"21627","type":"CPT"}],"standard_charges":[{"minimum":1923.63,"maximum":1923.63,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"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|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1923.63,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"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":3917.28,"maximum":3917.28,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"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|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":3917.28,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"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":1923.63,"maximum":1923.63,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"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|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1923.63,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"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":1923.63,"maximum":11624.04,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":11624.04,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1923.63,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5986.38,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":5812.02,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5812.02,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":6102.62,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6044.5,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":5812.02,"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":39135.64,"maximum":101686,"setting":"inpatient","payers_information":[{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":97237,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":101686,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":91545.34,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":50221,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":50221,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":80818,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":95564,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":88150,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":39135.64,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":45658.25,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":43484.04,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":44353.73,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":44353.73,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":44353.73,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":47145.86,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":46001.54,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":45772.67,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":48061.31,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":46916.99,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":45772.67,"methodology":"case rate"}]}]},{"description":"REVISION OF NECK MUSCLE","code_information":[{"code":"21700","type":"CPT"}],"standard_charges":[{"minimum":1923.63,"maximum":14037.14,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2376,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":2011,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":14037.14,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1923.63,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":7229.13,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":7369.5,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7299.31,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"}]}]},{"description":"REVISION OF NECK MUSCLE/RIB","code_information":[{"code":"21705","type":"CPT"}],"standard_charges":[{"minimum":1538.38,"maximum":1538.38,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"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|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"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":2657.78,"maximum":6375.52,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":3796,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3212,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":6375.52,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":2657.78,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3283.39,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":3187.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3187.76,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":3347.15,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3315.27,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":3187.76,"methodology":"case rate"}]}]},{"description":"REVISION OF NECK MUSCLE","code_information":[{"code":"21725","type":"CPT"}],"standard_charges":[{"minimum":691.26,"maximum":3796,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":3796,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3212,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":1382.52,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":2657.78,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":712,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":691.26,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":691.26,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":725.82,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":718.91,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":691.26,"methodology":"case rate"}]}]},{"description":"RECONSTRUCTION OF STERNUM","code_information":[{"code":"21740","type":"CPT"}],"standard_charges":[{"minimum":1923.63,"maximum":1923.63,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"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|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1923.63,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"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":3187.76,"maximum":6375.52,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":6375.52,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":4266.22,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3283.39,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":3187.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3187.76,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":3347.15,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3315.27,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":3187.76,"methodology":"case rate"}]}]},{"description":"REPAIR STERNUM/NUSS W/SCOPE","code_information":[{"code":"21743","type":"CPT"}],"standard_charges":[{"minimum":3187.76,"maximum":6375.52,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":6375.52,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":4266.22,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3283.39,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":3187.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3187.76,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":3347.15,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3315.27,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":3187.76,"methodology":"case rate"}]}]},{"description":"REPAIR OF STERNUM SEPARATION","code_information":[{"code":"21750","type":"CPT"}],"standard_charges":[{"minimum":1538.38,"maximum":1538.38,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"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|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"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":36076.55,"maximum":93678,"setting":"inpatient","payers_information":[{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":89579,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":93678,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":84389.56,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":50221,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":50221,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":74453,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":88038,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":81208,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":36076.55,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":42089.31,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":40085.05,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":40886.76,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":40886.76,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":40886.76,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":43460.63,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":42405.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":42194.78,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":44304.52,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":43249.65,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":42194.78,"methodology":"case rate"}]}]},{"description":"OPTX OF RIB FX W/FIXJ SCOPE","code_information":[{"code":"21811","type":"CPT"}],"standard_charges":[{"minimum":1923.63,"maximum":14037.14,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":14037.14,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1923.63,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":7229.13,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":7369.5,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7299.31,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"}]}]},{"description":"TREATMENT OF RIB FRACTURE","code_information":[{"code":"21812","type":"CPT"}],"standard_charges":[{"minimum":1923.63,"maximum":14037.14,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":14037.14,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1923.63,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":7229.13,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":7369.5,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7299.31,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"}]}]},{"description":"TREATMENT OF RIB FRACTURE","code_information":[{"code":"21813","type":"CPT"}],"standard_charges":[{"minimum":1572.37,"maximum":3144.74,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":3144.74,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1923.63,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1619.54,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":1572.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1572.37,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":1650.99,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1635.26,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":1572.37,"methodology":"case rate"}]}]},{"description":"HC CL TRT FX STERNUM","code_information":[{"code":"21820","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":480.48,"maximum":480.48,"gross_charge":528,"discounted_cash":248.74,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":480.48,"methodology":"fee schedule"}]}]},{"description":"HC CL TRT FX STERNUM","code_information":[{"code":"21820","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":124.03,"maximum":2152,"gross_charge":528,"discounted_cash":248.74,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":332.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":332.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":332.64,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2152,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":1821,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":471.36,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":332.64,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":332.64,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":480.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":253.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":396,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":142.56,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":149.69,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":139.71,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":124.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":145.42,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":146.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":242.75,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":235.68,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":235.68,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":247.46,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":245.11,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":235.68,"methodology":"case rate"}]}]},{"description":"TREAT STERNUM FRACTURE","code_information":[{"code":"21825","type":"CPT"}],"standard_charges":[{"minimum":1538.38,"maximum":1538.38,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"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|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"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":228.15,"maximum":1538.38,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":456.3,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":234.99,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":228.15,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":228.15,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":239.56,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":237.28,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":228.15,"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":38505,"maximum":121835,"setting":"inpatient","payers_information":[{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":116504,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":121835,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":109548.78,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":38505,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":38505,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":96831,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":114500,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":105617,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":46832.12,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":54637.47,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":52035.68,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":53076.4,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":53076.4,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":53076.4,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":56417.63,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":55048.27,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":54774.39,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":57513.11,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":56143.75,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":54774.39,"methodology":"case rate"}]}]},{"description":"BIOPSY SOFT TISSUE OF BACK","code_information":[{"code":"21920","type":"CPT"}],"standard_charges":[{"minimum":1538.38,"maximum":3183.7,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":3183.7,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1639.61,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":1591.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1591.85,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":1671.44,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1655.52,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":1591.85,"methodology":"case rate"}]}]},{"description":"BIOPSY SOFT TISSUE OF BACK","code_information":[{"code":"21925","type":"CPT"}],"standard_charges":[{"minimum":1591.85,"maximum":3183.7,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2376,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":2011,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":3183.7,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1923.63,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1639.61,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":1591.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1591.85,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":1671.44,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1655.52,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":1591.85,"methodology":"case rate"}]}]},{"description":"EXC BACK LES SC < 3 CM","code_information":[{"code":"21930","type":"CPT"}],"standard_charges":[{"minimum":1591.85,"maximum":3183.7,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2376,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":2011,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":3183.7,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1923.63,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1639.61,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":1591.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1591.85,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":1671.44,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1655.52,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":1591.85,"methodology":"case rate"}]}]},{"description":"EXC BACK LES SC 3 CM/>","code_information":[{"code":"21931","type":"CPT"}],"standard_charges":[{"minimum":1538.38,"maximum":3183.7,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2376,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":2011,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":3183.7,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1639.61,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":1591.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1591.85,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":1671.44,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1655.52,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":1591.85,"methodology":"case rate"}]}]},{"description":"EXC BACK TUM DEEP < 5 CM","code_information":[{"code":"21932","type":"CPT"}],"standard_charges":[{"minimum":1538.38,"maximum":5623.82,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2376,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":2011,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":5623.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2896.27,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":2811.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2811.91,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":2952.51,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2924.39,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":2811.91,"methodology":"case rate"}]}]},{"description":"EXC BACK TUM DEEP 5 CM/>","code_information":[{"code":"21933","type":"CPT"}],"standard_charges":[{"minimum":1538.38,"maximum":5623.82,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2376,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":2011,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":5623.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2896.27,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":2811.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2811.91,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":2952.51,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2924.39,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":2811.91,"methodology":"case rate"}]}]},{"description":"RESECT BACK TUM < 5 CM","code_information":[{"code":"21935","type":"CPT"}],"standard_charges":[{"minimum":2657.78,"maximum":5623.82,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":3796,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3212,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":5623.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":2657.78,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2896.27,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":2811.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2811.91,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":2952.51,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2924.39,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":2811.91,"methodology":"case rate"}]}]},{"description":"RESECT BACK TUM 5 CM/>","code_information":[{"code":"21936","type":"CPT"}],"standard_charges":[{"minimum":1538.38,"maximum":5623.82,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":5623.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2896.27,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":2811.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2811.91,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":2952.51,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2924.39,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":2811.91,"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":32151.33,"maximum":83402,"setting":"inpatient","payers_information":[{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":79752,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":83402,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":75207.76,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":38505,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":38505,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":66286,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":78381,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":72300,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":32151.33,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":37509.88,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":35723.69,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":36438.17,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":36438.17,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":36438.17,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":38732,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":37791.9,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":37603.88,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":39484.08,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":38543.98,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":37603.88,"methodology":"case rate"}]}]},{"description":"ID P-SPINE C/T/CERV-THOR","code_information":[{"code":"22010","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"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|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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":52,"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":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"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":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"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|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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":52,"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":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"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 WITHOUT CARDIAC CATHETERIZATION WITHOUT CC/MCC","code_information":[{"code":"221","type":"MS-DRG"}],"standard_charges":[{"minimum":27916.34,"maximum":72315,"setting":"inpatient","payers_information":[{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":69151,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":72315,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":65301.36,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":38505,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":38505,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":57474,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":67961,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":62689,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":27916.34,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":32569.06,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":31018.15,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":31638.52,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":31638.52,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":31638.52,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":33630.21,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":32813.94,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":32650.68,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":34283.22,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":33466.95,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":32650.68,"methodology":"case rate"}]}]},{"description":"REMOVE PART OF NECK VERTEBRA","code_information":[{"code":"22100","type":"CPT"}],"standard_charges":[{"minimum":4266.22,"maximum":14037.14,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":14037.14,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":4266.22,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":7229.13,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":7369.5,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7299.31,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"}]}]},{"description":"REMOVE PART THORAX VERTEBRA","code_information":[{"code":"22101","type":"CPT"}],"standard_charges":[{"minimum":4266.22,"maximum":14037.14,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":14037.14,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":4266.22,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":7229.13,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":7369.5,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7299.31,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"}]}]},{"description":"REMOVE PART LUMBAR VERTEBRA","code_information":[{"code":"22102","type":"CPT"}],"standard_charges":[{"minimum":4266.22,"maximum":14037.14,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":14037.14,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":4266.22,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":7229.13,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":7369.5,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7299.31,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"}]}]},{"description":"REMOVE EXTRA SPINE SEGMENT","code_information":[{"code":"22103","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"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|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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":52,"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":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"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":1923.63,"maximum":1923.63,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"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|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1923.63,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"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":1923.63,"maximum":1923.63,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"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|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1923.63,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"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":1538.38,"maximum":1538.38,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"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|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"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":1538.38,"maximum":1538.38,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"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|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"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":50221,"maximum":50221,"setting":"inpatient","payers_information":[{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_percentage":50,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_percentage":46,"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|All Other Plans","standard_charge_dollar":50221,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":50221,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"INCIS SPINE 3 COLUMN THORAC","code_information":[{"code":"22206","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"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|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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":52,"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":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"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":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"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|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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":52,"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":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"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":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"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|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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":52,"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":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"INCIS 1 VERTEBRAL SEG CERV","code_information":[{"code":"22210","type":"CPT"}],"standard_charges":[{"minimum":3078.06,"maximum":3078.06,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"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|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":3078.06,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"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":3917.28,"maximum":3917.28,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"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|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":3917.28,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"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":3078.06,"maximum":3078.06,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"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|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":3078.06,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"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":1538.38,"maximum":1538.38,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"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|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"INCIS W/DISCECTOMY CERVICAL","code_information":[{"code":"22220","type":"CPT"}],"standard_charges":[{"minimum":3078.06,"maximum":3078.06,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"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|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":3078.06,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"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":3078.06,"maximum":3078.06,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"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|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":3078.06,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"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":3078.06,"maximum":3078.06,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"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|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":3078.06,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"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":1538.38,"maximum":1538.38,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"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|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"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":"223","type":"MS-DRG"}],"standard_charges":[{"minimum":50221,"maximum":50221,"setting":"inpatient","payers_information":[{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_percentage":50,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_percentage":46,"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|All Other Plans","standard_charge_dollar":50221,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":50221,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC CL TRT FX VERT BDY WO MANIP","code_information":[{"code":"22310","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":1162.07,"maximum":1162.07,"gross_charge":1277,"discounted_cash":601.58,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1162.07,"methodology":"fee schedule"}]}]},{"description":"HC CL TRT FX VERT BDY WO MANIP","code_information":[{"code":"22310","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":235.68,"maximum":2152,"gross_charge":1277,"discounted_cash":601.58,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":804.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":804.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":804.51,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2152,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":1821,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":471.36,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":804.51,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":804.51,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1162.07,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":612.96,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":957.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":344.79,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":362.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":337.9,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":299.97,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":351.69,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":355.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":242.75,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":235.68,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":235.68,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":247.46,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":245.11,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":235.68,"methodology":"case rate"}]}]},{"description":"CLOSED TX VERT FX W/MANJ","code_information":[{"code":"22315","type":"CPT"}],"standard_charges":[{"minimum":1923.63,"maximum":6375.52,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2376,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":2011,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":6375.52,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1923.63,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3283.39,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":3187.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3187.76,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":3347.15,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3315.27,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":3187.76,"methodology":"case rate"}]}]},{"description":"TREAT ODONTOID FX W/O GRAFT","code_information":[{"code":"22318","type":"CPT"}],"standard_charges":[{"minimum":3917.28,"maximum":3917.28,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"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|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":3917.28,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"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":3078.06,"maximum":3078.06,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"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|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":3078.06,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"TREAT SPINE FRACTURE","code_information":[{"code":"22325","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"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|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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":52,"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":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"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":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"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|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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":52,"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":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"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":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"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|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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":52,"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":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"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":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"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|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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":52,"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":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"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":"224","type":"MS-DRG"}],"standard_charges":[{"minimum":50221,"maximum":50221,"setting":"inpatient","payers_information":[{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_percentage":50,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_percentage":46,"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|All Other Plans","standard_charge_dollar":50221,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":50221,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"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":"225","type":"MS-DRG"}],"standard_charges":[{"minimum":50221,"maximum":50221,"setting":"inpatient","payers_information":[{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_percentage":50,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_percentage":46,"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|All Other Plans","standard_charge_dollar":50221,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":50221,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"MANIPULATION OF SPINE","code_information":[{"code":"22505","type":"CPT"}],"standard_charges":[{"minimum":1572.37,"maximum":3144.74,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2376,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":2011,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":3144.74,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1923.63,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1619.54,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":1572.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1572.37,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":1650.99,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1635.26,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":1572.37,"methodology":"case rate"}]}]},{"description":"PERQ CERVICOTHORACIC INJECT","code_information":[{"code":"22510","type":"CPT"}],"standard_charges":[{"minimum":3187.76,"maximum":6375.52,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":5792,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":4901,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":6375.52,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":5385.62,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3283.39,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":3187.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3187.76,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":3347.15,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3315.27,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":3187.76,"methodology":"case rate"}]}]},{"description":"PERQ LUMBOSACRAL INJECTION","code_information":[{"code":"22511","type":"CPT"}],"standard_charges":[{"minimum":3187.76,"maximum":6375.52,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":5792,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":4901,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":6375.52,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":5385.62,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3283.39,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":3187.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3187.76,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":3347.15,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3315.27,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":3187.76,"methodology":"case rate"}]}]},{"description":"VERTEBROPLASTY ADDL INJECT","code_information":[{"code":"22512","type":"CPT"}],"standard_charges":[{"minimum":4901,"maximum":5792,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":5792,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":4901,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":5385.62,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"PERQ VERTEBRAL AUGMENTATION","code_information":[{"code":"22513","type":"CPT"}],"standard_charges":[{"minimum":4901,"maximum":14037.14,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":5792,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":4901,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":14037.14,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":5385.62,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":7229.13,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":7369.5,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7299.31,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"}]}]},{"description":"HC PERC KYPHOPLASTY LUMB 1 V","code_information":[{"code":"22514","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":14323.4,"maximum":14323.4,"gross_charge":15740,"discounted_cash":7414.85,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":14323.4,"methodology":"fee schedule"}]}]},{"description":"HC PERC KYPHOPLASTY LUMB 1 V","code_information":[{"code":"22514","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":3697.33,"maximum":14323.4,"gross_charge":15740,"discounted_cash":7414.85,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9916.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":9916.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9916.2,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":5792,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":4901,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":14037.14,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9916.2,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":9916.2,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":5385.62,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":14323.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7555.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":11805,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":4249.8,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":4462.29,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":4164.81,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":3697.33,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":4334.8,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4377.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":7229.13,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":7369.5,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7299.31,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"}]}]},{"description":"PERQ VERTEBRAL AUGMENTATION","code_information":[{"code":"22515","type":"CPT"}],"standard_charges":[{"minimum":4901,"maximum":5792,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":5792,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":4901,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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":52,"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":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"IDET SINGLE LEVEL","code_information":[{"code":"22526","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"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|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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":52,"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":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"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":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"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|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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":52,"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":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"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":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"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|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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":52,"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":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"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":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"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|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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":52,"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":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"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":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"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|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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":52,"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":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"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":3497.02,"maximum":3497.02,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"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|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":3497.02,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"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":5385.62,"maximum":25282.78,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"median_amount":4101.05,"10th_percentile":4101.05,"90th_percentile":4101.05,"count":"1 through 10","methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"median_amount":4101.05,"10th_percentile":4101.05,"90th_percentile":4101.05,"count":"1 through 10","methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"median_amount":4101.05,"10th_percentile":4101.05,"90th_percentile":4101.05,"count":"1 through 10","methodology":"percent of total billed charges"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":25282.78,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"median_amount":1942.01,"10th_percentile":1601.41,"90th_percentile":2956.8,"count":"1 through 10","methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"median_amount":1942.01,"10th_percentile":1601.41,"90th_percentile":2956.8,"count":"1 through 10","methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":5385.62,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_percentage":48,"median_amount":1227.15,"10th_percentile":1181.87,"90th_percentile":2092.77,"count":"1 through 10","methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"median_amount":1531.46,"10th_percentile":686.67,"90th_percentile":1756.83,"count":"1 through 10","methodology":"percent of total billed charges"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"median_amount":953.86,"10th_percentile":900.66,"90th_percentile":953.86,"count":"1 through 10","methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"median_amount":964.04,"10th_percentile":768.69,"90th_percentile":1853.06,"count":"1 through 10","methodology":"percent of total billed charges"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":13020.63,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":12641.39,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":12641.39,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":13273.46,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":13147.05,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":12641.39,"methodology":"case rate"}]}]},{"description":"ADDL NECK SPINE FUSION","code_information":[{"code":"22552","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"median_amount":4101.05,"10th_percentile":4101.05,"90th_percentile":4101.05,"count":"1 through 10","methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"median_amount":4101.05,"10th_percentile":4101.05,"90th_percentile":4101.05,"count":"1 through 10","methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"median_amount":4101.05,"10th_percentile":4101.05,"90th_percentile":4101.05,"count":"1 through 10","methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"median_amount":1601.41,"10th_percentile":1601.41,"90th_percentile":1601.41,"count":"1 through 10","methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"median_amount":1601.41,"10th_percentile":1601.41,"90th_percentile":1601.41,"count":"1 through 10","methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_percentage":52,"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":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_percentage":48,"median_amount":1227.15,"10th_percentile":1181.87,"90th_percentile":1227.15,"count":"1 through 10","methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"median_amount":1756.83,"10th_percentile":686.67,"90th_percentile":1756.83,"count":"1 through 10","methodology":"percent of total billed charges"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"median_amount":953.86,"10th_percentile":900.66,"90th_percentile":953.86,"count":"1 through 10","methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"median_amount":964.04,"10th_percentile":964.04,"90th_percentile":964.04,"count":"1 through 10","methodology":"percent of total billed charges"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"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":5385.62,"maximum":25282.78,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":25282.78,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":5385.62,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":13020.63,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":12641.39,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":12641.39,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":13273.46,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":13147.05,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":12641.39,"methodology":"case rate"}]}]},{"description":"THORAX SPINE FUSION","code_information":[{"code":"22556","type":"CPT"}],"standard_charges":[{"minimum":3078.06,"maximum":3078.06,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"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|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":3078.06,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"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":3078.06,"maximum":3078.06,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"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|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":3078.06,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_percentage":48,"median_amount":3110.8,"10th_percentile":3110.8,"90th_percentile":3110.8,"count":"1 through 10","methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"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":1538.38,"maximum":1538.38,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"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|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"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":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"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|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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":52,"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":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"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":3078.06,"maximum":3078.06,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"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|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":3078.06,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"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":3917.28,"maximum":3917.28,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"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|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":3917.28,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"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":38505,"maximum":38505,"setting":"inpatient","payers_information":[{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_percentage":50,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_percentage":46,"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|All Other Plans","standard_charge_dollar":38505,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":38505,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"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":"22600","type":"CPT"}],"standard_charges":[{"minimum":1923.63,"maximum":1923.63,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"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|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1923.63,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"THORAX SPINE FUSION","code_information":[{"code":"22610","type":"CPT"}],"standard_charges":[{"minimum":1923.63,"maximum":1923.63,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"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|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1923.63,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC SPINAL FUSION","code_information":[{"code":"22612","type":"CPT"},{"code":"0360","type":"RC"}],"standard_charges":[{"minimum":2586.22,"maximum":2586.22,"gross_charge":2842,"discounted_cash":1338.82,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2586.22,"methodology":"fee schedule"}]}]},{"description":"HC SPINAL FUSION","code_information":[{"code":"22612","type":"CPT"},{"code":"0360","type":"RC"}],"standard_charges":[{"minimum":667.59,"maximum":36135.72,"gross_charge":2842,"discounted_cash":1338.82,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1790.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1790.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1790.46,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":36135.72,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1790.46,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":1790.46,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3078.06,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2586.22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1364.16,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":2131.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":767.34,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":805.71,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":752,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":667.59,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":782.69,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":790.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":18609.9,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":18067.86,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":18067.86,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":18971.25,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":18790.57,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":18067.86,"methodology":"case rate"}]}]},{"description":"SPINE FUSION EXTRA SEGMENT","code_information":[{"code":"22614","type":"CPT"}],"standard_charges":[{"minimum":1538.38,"maximum":1538.38,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"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|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"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":"22630","type":"CPT"}],"standard_charges":[{"minimum":3078.06,"maximum":36135.72,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":36135.72,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":3078.06,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_percentage":48,"median_amount":10000,"10th_percentile":8475.83,"90th_percentile":10000,"count":"1 through 10","methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"median_amount":3977.71,"10th_percentile":3977.71,"90th_percentile":3977.71,"count":"1 through 10","methodology":"percent of total billed charges"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"median_amount":553.21,"10th_percentile":553.21,"90th_percentile":553.21,"count":"1 through 10","methodology":"percent of total billed charges"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":18609.9,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":18067.86,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":18067.86,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":18971.25,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":18790.57,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":18067.86,"methodology":"case rate"}]}]},{"description":"SPINE FUSION EXTRA SEGMENT","code_information":[{"code":"22632","type":"CPT"}],"standard_charges":[{"minimum":1538.38,"maximum":1538.38,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"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|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"median_amount":3977.71,"10th_percentile":3977.71,"90th_percentile":3977.71,"count":"1 through 10","methodology":"percent of total billed charges"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"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":18067.86,"maximum":36135.72,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":36135.72,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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":52,"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":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_percentage":48,"median_amount":1487.48,"10th_percentile":1487.48,"90th_percentile":1487.48,"count":"1 through 10","methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"median_amount":1059.47,"10th_percentile":1059.47,"90th_percentile":1059.47,"count":"1 through 10","methodology":"percent of total billed charges"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":18609.9,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":18067.86,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":18067.86,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":18971.25,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":18790.57,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":18067.86,"methodology":"case rate"}]}]},{"description":"SPINE FUSION EXTRA SEGMENT","code_information":[{"code":"22634","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"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|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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":52,"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":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"median_amount":1059.47,"10th_percentile":1059.47,"90th_percentile":1059.47,"count":"1 through 10","methodology":"percent of total billed charges"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"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":"227","type":"MS-DRG"}],"standard_charges":[{"minimum":38505,"maximum":38505,"setting":"inpatient","payers_information":[{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_percentage":50,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_percentage":46,"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|All Other Plans","standard_charge_dollar":38505,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":38505,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"OTHER CARDIOTHORACIC PROCEDURES WITH MCC","code_information":[{"code":"228","type":"MS-DRG"}],"standard_charges":[{"minimum":30142,"maximum":78467,"setting":"inpatient","payers_information":[{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":75034,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":78467,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":70798.34,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":30142,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":30142,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":62364,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":73743,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":68022,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":30266.3,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":35310.69,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":33629.22,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":34301.81,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":34301.81,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":34301.81,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":36461.15,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":35576.17,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":35399.17,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":37169.13,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":36284.15,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":35399.17,"methodology":"case rate"}]}]},{"description":"POST FUSION </6 VERT SEG","code_information":[{"code":"22800","type":"CPT"}],"standard_charges":[{"minimum":3917.28,"maximum":3917.28,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"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|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":3917.28,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"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":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"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|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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":52,"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":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"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":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"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|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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":52,"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":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"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":3497.02,"maximum":3497.02,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"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|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":3497.02,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"ANT FUSION 4-7 VERT SEG","code_information":[{"code":"22810","type":"CPT"}],"standard_charges":[{"minimum":3497.02,"maximum":3497.02,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"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|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":3497.02,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"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":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"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|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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":52,"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":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"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":3497.02,"maximum":3497.02,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"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|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":3497.02,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"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":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"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|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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":52,"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":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"EXPLORATION OF SPINAL FUSION","code_information":[{"code":"22830","type":"CPT"}],"standard_charges":[{"minimum":1538.38,"maximum":1538.38,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"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|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"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":"22840","type":"CPT"}],"standard_charges":[{"minimum":1538.38,"maximum":1538.38,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"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|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_percentage":48,"median_amount":1487.48,"10th_percentile":1487.48,"90th_percentile":1487.48,"count":"1 through 10","methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"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":1538.38,"maximum":1538.38,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"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|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"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":1538.38,"maximum":1538.38,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"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|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"median_amount":1059.47,"10th_percentile":1059.47,"90th_percentile":1059.47,"count":"1 through 10","methodology":"percent of total billed charges"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"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":1538.38,"maximum":1538.38,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"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|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"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":1538.38,"maximum":1538.38,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"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|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"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":1538.38,"maximum":1538.38,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"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|All Other Plans","standard_charge_percentage":63,"median_amount":1942.01,"10th_percentile":1942.01,"90th_percentile":1942.01,"count":"1 through 10","methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"median_amount":1942.01,"10th_percentile":1942.01,"90th_percentile":1942.01,"count":"1 through 10","methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_percentage":48,"median_amount":1227.15,"10th_percentile":1227.15,"90th_percentile":1227.15,"count":"1 through 10","methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"median_amount":1393.42,"10th_percentile":686.67,"90th_percentile":1393.42,"count":"1 through 10","methodology":"percent of total billed charges"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"median_amount":964.04,"10th_percentile":768.69,"90th_percentile":964.04,"count":"1 through 10","methodology":"percent of total billed charges"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"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":1538.38,"maximum":1538.38,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"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|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"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":1538.38,"maximum":1538.38,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"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|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"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":1538.38,"maximum":1538.38,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"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|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"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":3917.28,"maximum":3917.28,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"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|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":3917.28,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"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":1538.38,"maximum":1538.38,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"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|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"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":1538.38,"maximum":1538.38,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"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|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"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":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"median_amount":4101.05,"10th_percentile":4101.05,"90th_percentile":4101.05,"count":"1 through 10","methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"median_amount":4101.05,"10th_percentile":4101.05,"90th_percentile":4101.05,"count":"1 through 10","methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"median_amount":4101.05,"10th_percentile":4101.05,"90th_percentile":4101.05,"count":"1 through 10","methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"median_amount":1601.41,"10th_percentile":1601.41,"90th_percentile":1942.01,"count":"1 through 10","methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"median_amount":1601.41,"10th_percentile":1601.41,"90th_percentile":1942.01,"count":"1 through 10","methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_percentage":52,"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":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_percentage":48,"median_amount":1487.48,"10th_percentile":1181.87,"90th_percentile":9833.53,"count":"1 through 10","methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"median_amount":1756.83,"10th_percentile":1393.42,"90th_percentile":1756.83,"count":"1 through 10","methodology":"percent of total billed charges"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"median_amount":3977.71,"10th_percentile":3977.71,"90th_percentile":3977.71,"count":"1 through 10","methodology":"percent of total billed charges"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"median_amount":953.86,"10th_percentile":900.66,"90th_percentile":953.86,"count":"1 through 10","methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"median_amount":964.04,"10th_percentile":553.21,"90th_percentile":1853.06,"count":"1 through 10","methodology":"percent of total billed charges"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"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":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"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|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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":52,"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":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"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":1923.63,"maximum":1923.63,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"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|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1923.63,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"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":5385.62,"maximum":36135.72,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":36135.72,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":5385.62,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"median_amount":4174.24,"10th_percentile":4174.24,"90th_percentile":4174.24,"count":"1 through 10","methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":18609.9,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":18067.86,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":18067.86,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":18971.25,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":18790.57,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":18067.86,"methodology":"case rate"}]}]},{"description":"LUMBAR ARTIF DISKECTOMY","code_information":[{"code":"22857","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"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|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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":52,"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":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"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":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"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|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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":52,"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":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"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":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"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|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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":52,"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":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"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":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"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|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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":52,"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":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"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":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"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|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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":52,"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":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"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":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"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|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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":52,"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":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"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":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"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|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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":52,"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":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"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":4901,"maximum":36135.72,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":5792,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":4901,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":36135.72,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":5385.62,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":18609.9,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":18067.86,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":18067.86,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":18971.25,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":18790.57,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":18067.86,"methodology":"case rate"}]}]},{"description":"INSJ STABLJ DEV W/DCMPRN","code_information":[{"code":"22868","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"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|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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":52,"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":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"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":4901,"maximum":25282.78,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":5792,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":4901,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":25282.78,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":5385.62,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":13020.63,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":12641.39,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":12641.39,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":13273.46,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":13147.05,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":12641.39,"methodology":"case rate"}]}]},{"description":"INSJ STABLJ DEV W/O DCMPRN","code_information":[{"code":"22870","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"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|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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":52,"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":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"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":235.68,"maximum":1538.38,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":471.36,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":242.75,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":235.68,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":235.68,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":247.46,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":245.11,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":235.68,"methodology":"case rate"}]}]},{"description":"OTHER CARDIOTHORACIC PROCEDURES WITHOUT MCC","code_information":[{"code":"229","type":"MS-DRG"}],"standard_charges":[{"minimum":18976.62,"maximum":48912,"setting":"inpatient","payers_information":[{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":46772,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":48912,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":44389.74,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":30142,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":30142,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":38874,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":45967,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":42401,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":18976.62,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":22139.39,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":21085.13,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":21506.84,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":21506.84,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":21506.84,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":22860.72,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":22305.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":22194.87,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":23304.62,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":22749.75,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":22194.87,"methodology":"case rate"}]}]},{"description":"EXC ABDL TUM DEEP < 5 CM","code_information":[{"code":"22900","type":"CPT"}],"standard_charges":[{"minimum":2811.91,"maximum":5623.82,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":4157,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3517,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":5623.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":3078.06,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2896.27,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":2811.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2811.91,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":2952.51,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2924.39,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":2811.91,"methodology":"case rate"}]}]},{"description":"EXC ABDL TUM DEEP 5 CM/>","code_information":[{"code":"22901","type":"CPT"}],"standard_charges":[{"minimum":1538.38,"maximum":5623.82,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":3796,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3212,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":5623.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2896.27,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":2811.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2811.91,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":2952.51,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2924.39,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":2811.91,"methodology":"case rate"}]}]},{"description":"EXC ABD LES SC < 3 CM","code_information":[{"code":"22902","type":"CPT"}],"standard_charges":[{"minimum":1538.38,"maximum":3183.7,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2376,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":2011,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":3183.7,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1639.61,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":1591.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1591.85,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":1671.44,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1655.52,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":1591.85,"methodology":"case rate"}]}]},{"description":"EXC ABD LES SC 3 CM/>","code_information":[{"code":"22903","type":"CPT"}],"standard_charges":[{"minimum":1538.38,"maximum":5623.82,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2376,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":2011,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":5623.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2896.27,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":2811.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2811.91,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":2952.51,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2924.39,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":2811.91,"methodology":"case rate"}]}]},{"description":"RADICAL RESECT ABD TUMOR<5CM","code_information":[{"code":"22904","type":"CPT"}],"standard_charges":[{"minimum":1538.38,"maximum":5623.82,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":5623.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2896.27,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":2811.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2811.91,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":2952.51,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2924.39,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":2811.91,"methodology":"case rate"}]}]},{"description":"RAD RESECT ABD TUMOR 5 CM/>","code_information":[{"code":"22905","type":"CPT"}],"standard_charges":[{"minimum":1538.38,"maximum":5623.82,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":5623.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2896.27,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":2811.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2811.91,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":2952.51,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2924.39,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":2811.91,"methodology":"case rate"}]}]},{"description":"ABDOMEN SURGERY PROCEDURE","code_information":[{"code":"22999","type":"CPT"}],"standard_charges":[{"minimum":235.68,"maximum":1538.38,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":471.36,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"median_amount":2945.21,"10th_percentile":2945.21,"90th_percentile":2945.21,"count":"1 through 10","methodology":"percent of total billed charges"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":242.75,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":235.68,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":235.68,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":247.46,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":245.11,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":235.68,"methodology":"case rate"}]}]},{"description":"NO ACTIVE CODE DESCRIPTION","code_information":[{"code":"230","type":"MS-DRG"}],"standard_charges":[{"minimum":30142,"maximum":30142,"setting":"inpatient","payers_information":[{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":30142,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":30142,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REMOVAL OF CALCIUM DEPOSITS","code_information":[{"code":"23000","type":"CPT"}],"standard_charges":[{"minimum":1923.63,"maximum":5623.82,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2376,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":2011,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":5623.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1923.63,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2896.27,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":2811.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2811.91,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":2952.51,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2924.39,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":2811.91,"methodology":"case rate"}]}]},{"description":"RELEASE SHOULDER JOINT","code_information":[{"code":"23020","type":"CPT"}],"standard_charges":[{"minimum":1923.63,"maximum":6375.52,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2376,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":2011,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":6375.52,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1923.63,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3283.39,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":3187.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3187.76,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":3347.15,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3315.27,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":3187.76,"methodology":"case rate"}]}]},{"description":"DRAIN SHOULDER LESION","code_information":[{"code":"23030","type":"CPT"}],"standard_charges":[{"minimum":1538.38,"maximum":5623.82,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2152,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":1821,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":5623.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2896.27,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":2811.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2811.91,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":2952.51,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2924.39,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":2811.91,"methodology":"case rate"}]}]},{"description":"DRAIN SHOULDER BURSA","code_information":[{"code":"23031","type":"CPT"}],"standard_charges":[{"minimum":2657.78,"maximum":5623.82,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":3796,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3212,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":5623.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":2657.78,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2896.27,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":2811.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2811.91,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":2952.51,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2924.39,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":2811.91,"methodology":"case rate"}]}]},{"description":"DRAIN SHOULDER BONE LESION","code_information":[{"code":"23035","type":"CPT"}],"standard_charges":[{"minimum":1572.37,"maximum":3796,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":3796,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3212,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":3144.74,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":2657.78,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1619.54,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":1572.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1572.37,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":1650.99,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1635.26,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":1572.37,"methodology":"case rate"}]}]},{"description":"EXPLORATORY SHOULDER SURGERY","code_information":[{"code":"23040","type":"CPT"}],"standard_charges":[{"minimum":2657.78,"maximum":6375.52,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":3796,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3212,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":6375.52,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":2657.78,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3283.39,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":3187.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3187.76,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":3347.15,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3315.27,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":3187.76,"methodology":"case rate"}]}]},{"description":"EXPLORATORY SHOULDER SURGERY","code_information":[{"code":"23044","type":"CPT"}],"standard_charges":[{"minimum":3078.06,"maximum":6375.52,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":4157,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3517,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":6375.52,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":3078.06,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3283.39,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":3187.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3187.76,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":3347.15,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3315.27,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":3187.76,"methodology":"case rate"}]}]},{"description":"BIOPSY SHOULDER TISSUES","code_information":[{"code":"23065","type":"CPT"}],"standard_charges":[{"minimum":1538.38,"maximum":3183.7,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":3183.7,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1639.61,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":1591.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1591.85,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":1671.44,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1655.52,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":1591.85,"methodology":"case rate"}]}]},{"description":"BIOPSY SHOULDER TISSUES","code_information":[{"code":"23066","type":"CPT"}],"standard_charges":[{"minimum":1923.63,"maximum":5623.82,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2376,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":2011,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":5623.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1923.63,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2896.27,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":2811.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2811.91,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":2952.51,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2924.39,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":2811.91,"methodology":"case rate"}]}]},{"description":"EXC SHOULDER LES SC 3 CM/>","code_information":[{"code":"23071","type":"CPT"}],"standard_charges":[{"minimum":1538.38,"maximum":3183.7,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2376,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":2011,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":3183.7,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_percentage":48,"median_amount":4498.84,"10th_percentile":4498.84,"90th_percentile":4498.84,"count":"1 through 10","methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1639.61,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":1591.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1591.85,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":1671.44,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1655.52,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":1591.85,"methodology":"case rate"}]}]},{"description":"EXC SHOULDER TUM DEEP 5 CM/>","code_information":[{"code":"23073","type":"CPT"}],"standard_charges":[{"minimum":1538.38,"maximum":5623.82,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2376,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":2011,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":5623.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2896.27,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":2811.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2811.91,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":2952.51,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2924.39,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":2811.91,"methodology":"case rate"}]}]},{"description":"EXC SHOULDER LES SC < 3 CM","code_information":[{"code":"23075","type":"CPT"}],"standard_charges":[{"minimum":1591.85,"maximum":3183.7,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2376,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":2011,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":3183.7,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1923.63,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1639.61,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":1591.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1591.85,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":1671.44,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1655.52,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":1591.85,"methodology":"case rate"}]}]},{"description":"EXC SHOULDER TUM DEEP < 5 CM","code_information":[{"code":"23076","type":"CPT"}],"standard_charges":[{"minimum":1923.63,"maximum":5623.82,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2376,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":2011,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":5623.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1923.63,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2896.27,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":2811.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2811.91,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":2952.51,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2924.39,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":2811.91,"methodology":"case rate"}]}]},{"description":"RESECT SHOULDER TUMOR < 5 CM","code_information":[{"code":"23077","type":"CPT"}],"standard_charges":[{"minimum":2657.78,"maximum":5623.82,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":3796,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3212,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":5623.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":2657.78,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2896.27,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":2811.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2811.91,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":2952.51,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2924.39,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":2811.91,"methodology":"case rate"}]}]},{"description":"RESECT SHOULDER TUMOR 5 CM/>","code_information":[{"code":"23078","type":"CPT"}],"standard_charges":[{"minimum":1538.38,"maximum":5623.82,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":5623.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2896.27,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":2811.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2811.91,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":2952.51,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2924.39,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":2811.91,"methodology":"case rate"}]}]},{"description":"CORONARY BYPASS WITH PTCA WITH MCC","code_information":[{"code":"231","type":"MS-DRG"}],"standard_charges":[{"minimum":33405,"maximum":133430,"setting":"inpatient","payers_information":[{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":127592,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":133430,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":119909.62,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":33405,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":33405,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":106047,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":125397,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":115669,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":51261.37,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":59804.93,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":56957.07,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":58096.22,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":58096.22,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":58096.22,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":61753.46,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":60254.59,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":59954.81,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":62952.56,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":61453.69,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":59954.81,"methodology":"case rate"}]}]},{"description":"BIOPSY OF SHOULDER JOINT","code_information":[{"code":"23100","type":"CPT"}],"standard_charges":[{"minimum":1923.63,"maximum":6375.52,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2376,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":2011,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":6375.52,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1923.63,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3283.39,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":3187.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3187.76,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":3347.15,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3315.27,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":3187.76,"methodology":"case rate"}]}]},{"description":"SHOULDER JOINT SURGERY","code_information":[{"code":"23101","type":"CPT"}],"standard_charges":[{"minimum":3187.76,"maximum":6375.52,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":5489,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":4645,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":6375.52,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":4336.27,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3283.39,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":3187.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3187.76,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":3347.15,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3315.27,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":3187.76,"methodology":"case rate"}]}]},{"description":"REMOVE SHOULDER JOINT LINING","code_information":[{"code":"23105","type":"CPT"}],"standard_charges":[{"minimum":3078.06,"maximum":14037.14,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":4157,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3517,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":14037.14,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":3078.06,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":7229.13,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":7369.5,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7299.31,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"}]}]},{"description":"INCISION OF COLLARBONE JOINT","code_information":[{"code":"23106","type":"CPT"}],"standard_charges":[{"minimum":3078.06,"maximum":6375.52,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":4157,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3517,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":6375.52,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":3078.06,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3283.39,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":3187.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3187.76,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":3347.15,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3315.27,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":3187.76,"methodology":"case rate"}]}]},{"description":"EXPLORE TREAT SHOULDER JOINT","code_information":[{"code":"23107","type":"CPT"}],"standard_charges":[{"minimum":3078.06,"maximum":14037.14,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":4157,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3517,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":14037.14,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":3078.06,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":7229.13,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":7369.5,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7299.31,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"}]}]},{"description":"PARTIAL REMOVAL COLLAR BONE","code_information":[{"code":"23120","type":"CPT"}],"standard_charges":[{"minimum":3187.76,"maximum":6375.52,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":4514,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3819,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":6375.52,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":3497.02,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3283.39,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":3187.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3187.76,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":3347.15,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3315.27,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":3187.76,"methodology":"case rate"}]}]},{"description":"REMOVAL OF COLLAR BONE","code_information":[{"code":"23125","type":"CPT"}],"standard_charges":[{"minimum":3187.76,"maximum":6375.52,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":4514,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3819,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":6375.52,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":3497.02,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3283.39,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":3187.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3187.76,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":3347.15,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3315.27,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":3187.76,"methodology":"case rate"}]}]},{"description":"REMOVE SHOULDER BONE PART","code_information":[{"code":"23130","type":"CPT"}],"standard_charges":[{"minimum":3187.76,"maximum":6375.52,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":4514,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3819,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":6375.52,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":3497.02,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3283.39,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":3187.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3187.76,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":3347.15,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3315.27,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":3187.76,"methodology":"case rate"}]}]},{"description":"REMOVAL OF BONE LESION","code_information":[{"code":"23140","type":"CPT"}],"standard_charges":[{"minimum":3078.06,"maximum":6375.52,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":4157,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3517,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":6375.52,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":3078.06,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3283.39,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":3187.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3187.76,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":3347.15,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3315.27,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":3187.76,"methodology":"case rate"}]}]},{"description":"REMOVAL OF BONE LESION","code_information":[{"code":"23145","type":"CPT"}],"standard_charges":[{"minimum":3187.76,"maximum":6375.52,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":4514,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3819,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":6375.52,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":3497.02,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3283.39,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":3187.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3187.76,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":3347.15,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3315.27,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":3187.76,"methodology":"case rate"}]}]},{"description":"REMOVAL OF BONE LESION","code_information":[{"code":"23146","type":"CPT"}],"standard_charges":[{"minimum":3497.02,"maximum":14037.14,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":4514,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3819,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":14037.14,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":3497.02,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":7229.13,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":7369.5,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7299.31,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"}]}]},{"description":"REMOVAL OF HUMERUS LESION","code_information":[{"code":"23150","type":"CPT"}],"standard_charges":[{"minimum":3078.06,"maximum":6375.52,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":4157,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3517,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":6375.52,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":3078.06,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3283.39,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":3187.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3187.76,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":3347.15,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3315.27,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":3187.76,"methodology":"case rate"}]}]},{"description":"REMOVAL OF HUMERUS LESION","code_information":[{"code":"23155","type":"CPT"}],"standard_charges":[{"minimum":3497.02,"maximum":14037.14,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":4514,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3819,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":14037.14,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":3497.02,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":7229.13,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":7369.5,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7299.31,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"}]}]},{"description":"REMOVAL OF HUMERUS LESION","code_information":[{"code":"23156","type":"CPT"}],"standard_charges":[{"minimum":3497.02,"maximum":14037.14,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":4514,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3819,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":14037.14,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":3497.02,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":7229.13,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":7369.5,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7299.31,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"}]}]},{"description":"REMOVE COLLAR BONE LESION","code_information":[{"code":"23170","type":"CPT"}],"standard_charges":[{"minimum":1923.63,"maximum":6375.52,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2376,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":2011,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":6375.52,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1923.63,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3283.39,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":3187.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3187.76,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":3347.15,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3315.27,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":3187.76,"methodology":"case rate"}]}]},{"description":"REMOVE SHOULDER BLADE LESION","code_information":[{"code":"23172","type":"CPT"}],"standard_charges":[{"minimum":1923.63,"maximum":6375.52,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2376,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":2011,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":6375.52,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1923.63,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3283.39,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":3187.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3187.76,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":3347.15,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3315.27,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":3187.76,"methodology":"case rate"}]}]},{"description":"REMOVE HUMERUS LESION","code_information":[{"code":"23174","type":"CPT"}],"standard_charges":[{"minimum":1923.63,"maximum":14037.14,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2376,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":2011,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":14037.14,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1923.63,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":7229.13,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":7369.5,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7299.31,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"}]}]},{"description":"REMOVE COLLAR BONE LESION","code_information":[{"code":"23180","type":"CPT"}],"standard_charges":[{"minimum":3078.06,"maximum":14037.14,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":4157,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3517,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":14037.14,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":3078.06,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":7229.13,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":7369.5,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7299.31,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"}]}]},{"description":"REMOVE SHOULDER BLADE LESION","code_information":[{"code":"23182","type":"CPT"}],"standard_charges":[{"minimum":3078.06,"maximum":14037.14,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":4157,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3517,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":14037.14,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":3078.06,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":7229.13,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":7369.5,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7299.31,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"}]}]},{"description":"REMOVE HUMERUS LESION","code_information":[{"code":"23184","type":"CPT"}],"standard_charges":[{"minimum":3078.06,"maximum":14037.14,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":4157,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3517,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":14037.14,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":3078.06,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":7229.13,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":7369.5,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7299.31,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"}]}]},{"description":"PARTIAL REMOVAL OF SCAPULA","code_information":[{"code":"23190","type":"CPT"}],"standard_charges":[{"minimum":3078.06,"maximum":6375.52,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":4157,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3517,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":6375.52,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":3078.06,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3283.39,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":3187.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3187.76,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":3347.15,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3315.27,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":3187.76,"methodology":"case rate"}]}]},{"description":"REMOVAL OF HEAD OF HUMERUS","code_information":[{"code":"23195","type":"CPT"}],"standard_charges":[{"minimum":3497.02,"maximum":14037.14,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":4514,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3819,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":14037.14,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":3497.02,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":7229.13,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":7369.5,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7299.31,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"}]}]},{"description":"CORONARY BYPASS WITH PTCA WITHOUT MCC","code_information":[{"code":"232","type":"MS-DRG"}],"standard_charges":[{"minimum":33405,"maximum":96188,"setting":"inpatient","payers_information":[{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":91979,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":96188,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":86632.24,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":33405,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":33405,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":76448,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":90397,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":83384,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":37035.29,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":43207.84,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":41150.32,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":41973.33,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":41973.33,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":41973.33,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":44615.61,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":43532.71,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":43316.12,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":45481.93,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":44399.03,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":43316.12,"methodology":"case rate"}]}]},{"description":"RESECT CLAVICLE TUMOR","code_information":[{"code":"23200","type":"CPT"}],"standard_charges":[{"minimum":3917.28,"maximum":3917.28,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"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|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":3917.28,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"RESECT SCAPULA TUMOR","code_information":[{"code":"23210","type":"CPT"}],"standard_charges":[{"minimum":3917.28,"maximum":3917.28,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"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|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":3917.28,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"RESECT PROX HUMERUS TUMOR","code_information":[{"code":"23220","type":"CPT"}],"standard_charges":[{"minimum":3078.06,"maximum":3078.06,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"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|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":3078.06,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"CORONARY BYPASS WITH CARDIAC CATHETERIZATION OR OPEN ABLATION WITH MCC","code_information":[{"code":"233","type":"MS-DRG"}],"standard_charges":[{"minimum":25052,"maximum":123077,"setting":"inpatient","payers_information":[{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":117692,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":123077,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":110658.88,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":25052,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":25052,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":97819,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":115667,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":106694,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":47306.68,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":55191.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":52562.97,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":53614.23,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":53614.23,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":53614.23,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":56989.33,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":55606.09,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":55329.44,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":58095.92,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":56712.68,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":55329.44,"methodology":"case rate"}]}]},{"description":"REMOVE SHOULDER FOREIGN BODY","code_information":[{"code":"23330","type":"CPT"}],"standard_charges":[{"minimum":1538.38,"maximum":3183.7,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2152,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":1821,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":3183.7,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1639.61,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":1591.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1591.85,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":1671.44,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1655.52,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":1591.85,"methodology":"case rate"}]}]},{"description":"REMOVE SHOULDER FB DEEP","code_information":[{"code":"23333","type":"CPT"}],"standard_charges":[{"minimum":1538.38,"maximum":5623.82,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2152,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":1821,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":5623.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2896.27,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":2811.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2811.91,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":2952.51,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2924.39,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":2811.91,"methodology":"case rate"}]}]},{"description":"SHOULDER PROSTHESIS REMOVAL","code_information":[{"code":"23334","type":"CPT"}],"standard_charges":[{"minimum":1538.38,"maximum":5623.82,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":3796,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3212,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":5623.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2896.27,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":2811.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2811.91,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":2952.51,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2924.39,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":2811.91,"methodology":"case rate"}]}]},{"description":"SHOULDER PROSTHESIS REMOVAL","code_information":[{"code":"23335","type":"CPT"}],"standard_charges":[{"minimum":3212,"maximum":3796,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":3796,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3212,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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":52,"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":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC INJECTION FOR SHOULDER ARTH","code_information":[{"code":"23350","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":505.05,"maximum":505.05,"gross_charge":555,"discounted_cash":261.46,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":505.05,"methodology":"fee schedule"}]}]},{"description":"HC INJECTION FOR SHOULDER ARTH","code_information":[{"code":"23350","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":130.37,"maximum":1538.38,"gross_charge":555,"discounted_cash":261.46,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":349.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":349.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":349.65,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":349.65,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":349.65,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":505.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":266.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":416.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":149.85,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":157.35,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":146.86,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":130.37,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":152.85,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":154.35,"methodology":"fee schedule"}]}]},{"description":"MUSCLE TRANSFER SHOULDER/ARM","code_information":[{"code":"23395","type":"CPT"}],"standard_charges":[{"minimum":3497.02,"maximum":14037.14,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":4514,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3819,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":14037.14,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":3497.02,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":7229.13,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":7369.5,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7299.31,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"}]}]},{"description":"MUSCLE TRANSFERS","code_information":[{"code":"23397","type":"CPT"}],"standard_charges":[{"minimum":4336.27,"maximum":14037.14,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":5489,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":4645,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":14037.14,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":4336.27,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":7229.13,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":7369.5,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7299.31,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"}]}]},{"description":"CORONARY BYPASS WITH CARDIAC CATHETERIZATION OR OPEN ABLATION WITHOUT MCC","code_information":[{"code":"234","type":"MS-DRG"}],"standard_charges":[{"minimum":25052,"maximum":83772,"setting":"inpatient","payers_information":[{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":80106,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":83772,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":75538.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":25052,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":25052,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":66580,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":78728,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":72621,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":32292.67,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":37674.78,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":35880.74,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":36598.36,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":36598.36,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":36598.36,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":38902.27,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":37958.04,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":37769.19,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":39657.65,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":38713.42,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":37769.19,"methodology":"case rate"}]}]},{"description":"FIXATION OF SHOULDER BLADE","code_information":[{"code":"23400","type":"CPT"}],"standard_charges":[{"minimum":4336.27,"maximum":14037.14,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":5489,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":4645,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":14037.14,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":4336.27,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":7229.13,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":7369.5,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7299.31,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"}]}]},{"description":"INCISION OF TENDON  MUSCLE","code_information":[{"code":"23405","type":"CPT"}],"standard_charges":[{"minimum":1923.63,"maximum":14037.14,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2376,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":2011,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":14037.14,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1923.63,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":7229.13,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":7369.5,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7299.31,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"}]}]},{"description":"INCISE TENDON(S)  MUSCLE(S)","code_information":[{"code":"23406","type":"CPT"}],"standard_charges":[{"minimum":1923.63,"maximum":14037.14,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2376,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":2011,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":14037.14,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1923.63,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":7229.13,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":7369.5,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7299.31,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"}]}]},{"description":"REPAIR ROTATOR CUFF ACUTE","code_information":[{"code":"23410","type":"CPT"}],"standard_charges":[{"minimum":3497.02,"maximum":14037.14,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":4514,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3819,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":14037.14,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":3497.02,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":7229.13,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":7369.5,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7299.31,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"}]}]},{"description":"REPAIR ROTATOR CUFF CHRONIC","code_information":[{"code":"23412","type":"CPT"}],"standard_charges":[{"minimum":4336.27,"maximum":14037.14,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":5489,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":4645,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":14037.14,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":4336.27,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":7229.13,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":7369.5,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7299.31,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"}]}]},{"description":"RELEASE OF SHOULDER LIGAMENT","code_information":[{"code":"23415","type":"CPT"}],"standard_charges":[{"minimum":3497.02,"maximum":14037.14,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":4514,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3819,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":14037.14,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":3497.02,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":7229.13,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":7369.5,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7299.31,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"}]}]},{"description":"REPAIR OF SHOULDER","code_information":[{"code":"23420","type":"CPT"}],"standard_charges":[{"minimum":4336.27,"maximum":14037.14,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":5489,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":4645,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":14037.14,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":4336.27,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":7229.13,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":7369.5,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7299.31,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"}]}]},{"description":"REPAIR BICEPS TENDON","code_information":[{"code":"23430","type":"CPT"}],"standard_charges":[{"minimum":3078.06,"maximum":14037.14,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":4157,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3517,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":14037.14,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":3078.06,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":7229.13,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":7369.5,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7299.31,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"}]}]},{"description":"REMOVE/TRANSPLANT TENDON","code_information":[{"code":"23440","type":"CPT"}],"standard_charges":[{"minimum":3078.06,"maximum":14037.14,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":4157,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3517,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":14037.14,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":3078.06,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":7229.13,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":7369.5,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7299.31,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"}]}]},{"description":"REPAIR SHOULDER CAPSULE","code_information":[{"code":"23450","type":"CPT"}],"standard_charges":[{"minimum":3497.02,"maximum":14037.14,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":4514,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3819,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":14037.14,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":3497.02,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":7229.13,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":7369.5,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7299.31,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"}]}]},{"description":"REPAIR SHOULDER CAPSULE","code_information":[{"code":"23455","type":"CPT"}],"standard_charges":[{"minimum":4336.27,"maximum":14037.14,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":5489,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":4645,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":14037.14,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":4336.27,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":7229.13,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":7369.5,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7299.31,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"}]}]},{"description":"REPAIR SHOULDER CAPSULE","code_information":[{"code":"23460","type":"CPT"}],"standard_charges":[{"minimum":3497.02,"maximum":14037.14,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":4514,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3819,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":14037.14,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":3497.02,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":7229.13,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":7369.5,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7299.31,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"}]}]},{"description":"REPAIR SHOULDER CAPSULE","code_information":[{"code":"23462","type":"CPT"}],"standard_charges":[{"minimum":4336.27,"maximum":14037.14,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":5489,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":4645,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":14037.14,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":4336.27,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":7229.13,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":7369.5,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7299.31,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"}]}]},{"description":"REPAIR SHOULDER CAPSULE","code_information":[{"code":"23465","type":"CPT"}],"standard_charges":[{"minimum":3497.02,"maximum":14037.14,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":4514,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3819,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":14037.14,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":3497.02,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":7229.13,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":7369.5,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7299.31,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"}]}]},{"description":"REPAIR SHOULDER CAPSULE","code_information":[{"code":"23466","type":"CPT"}],"standard_charges":[{"minimum":4336.27,"maximum":14037.14,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":5489,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":4645,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":14037.14,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":4336.27,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":7229.13,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":7369.5,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7299.31,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"}]}]},{"description":"RECONSTRUCT SHOULDER JOINT","code_information":[{"code":"23470","type":"CPT"}],"standard_charges":[{"minimum":5385.62,"maximum":25282.78,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":25282.78,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":5385.62,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":13020.63,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":12641.39,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":12641.39,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":13273.46,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":13147.05,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":12641.39,"methodology":"case rate"}]}]},{"description":"RECONSTRUCT SHOULDER JOINT","code_information":[{"code":"23472","type":"CPT"}],"standard_charges":[{"minimum":3078.06,"maximum":36135.72,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":36135.72,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":3078.06,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":18609.9,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":18067.86,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":18067.86,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":18971.25,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":18790.57,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":18067.86,"methodology":"case rate"}]}]},{"description":"REVIS RECONST SHOULDER JOINT","code_information":[{"code":"23473","type":"CPT"}],"standard_charges":[{"minimum":3497.02,"maximum":25282.78,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":25282.78,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":3497.02,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":13020.63,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":12641.39,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":12641.39,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":13273.46,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":13147.05,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":12641.39,"methodology":"case rate"}]}]},{"description":"REVIS RECONST SHOULDER JOINT","code_information":[{"code":"23474","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"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|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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":52,"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":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"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":3078.06,"maximum":14037.14,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":4157,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3517,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":14037.14,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":3078.06,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":7229.13,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":7369.5,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7299.31,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"}]}]},{"description":"REVISION OF COLLAR BONE","code_information":[{"code":"23485","type":"CPT"}],"standard_charges":[{"minimum":4336.27,"maximum":25282.78,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":5489,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":4645,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":25282.78,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":4336.27,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":13020.63,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":12641.39,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":12641.39,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":13273.46,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":13147.05,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":12641.39,"methodology":"case rate"}]}]},{"description":"REINFORCE CLAVICLE","code_information":[{"code":"23490","type":"CPT"}],"standard_charges":[{"minimum":2657.78,"maximum":14037.14,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":3796,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3212,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":14037.14,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":2657.78,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":7229.13,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":7369.5,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7299.31,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"}]}]},{"description":"REINFORCE SHOULDER BONES","code_information":[{"code":"23491","type":"CPT"}],"standard_charges":[{"minimum":2657.78,"maximum":25282.78,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":3796,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3212,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":25282.78,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":2657.78,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":13020.63,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":12641.39,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":12641.39,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":13273.46,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":13147.05,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":12641.39,"methodology":"case rate"}]}]},{"description":"CORONARY BYPASS WITHOUT CARDIAC CATHETERIZATION WITH MCC","code_information":[{"code":"235","type":"MS-DRG"}],"standard_charges":[{"minimum":25948,"maximum":92653,"setting":"inpatient","payers_information":[{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":88598,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":92653,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":83473.62,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":25948,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":25948,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":73638,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":87074,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":80319,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":35684.98,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":41632.47,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":39649.97,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":40442.97,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":40442.97,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":40442.97,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":42988.92,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":41945.5,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":41736.81,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":43823.66,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":42780.24,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":41736.81,"methodology":"case rate"}]}]},{"description":"HC CL TX CLAVICULAR FX WO MANP","code_information":[{"code":"23500","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":480.48,"maximum":480.48,"gross_charge":528,"discounted_cash":248.74,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":480.48,"methodology":"fee schedule"}]}]},{"description":"HC CL TX CLAVICULAR FX WO MANP","code_information":[{"code":"23500","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":124.03,"maximum":2152,"gross_charge":528,"discounted_cash":248.74,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":332.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":332.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":332.64,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2152,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":1821,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":471.36,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":332.64,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":332.64,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":480.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":253.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":396,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":142.56,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":149.69,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":139.71,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":124.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":145.42,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":146.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":242.75,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":235.68,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":235.68,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":247.46,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":245.11,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":235.68,"methodology":"case rate"}]}]},{"description":"HC CL TX CLAVICAL W/MNP","code_information":[{"code":"23505","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":5493.67,"maximum":5493.67,"gross_charge":6037,"discounted_cash":2843.93,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5493.67,"methodology":"fee schedule"}]}]},{"description":"HC CL TX CLAVICAL W/MNP","code_information":[{"code":"23505","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":1418.1,"maximum":5493.67,"gross_charge":6037,"discounted_cash":2843.93,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3803.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3803.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3803.31,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2152,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":1821,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":3144.74,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3803.31,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3803.31,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5493.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2897.76,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":4527.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":1629.99,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":1711.49,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":1597.4,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":1418.1,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1662.59,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1678.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1619.54,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":1572.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1572.37,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":1650.99,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1635.26,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":1572.37,"methodology":"case rate"}]}]},{"description":"TREAT CLAVICLE FRACTURE","code_information":[{"code":"23515","type":"CPT"}],"standard_charges":[{"minimum":2657.78,"maximum":14037.14,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":3796,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3212,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":14037.14,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":2657.78,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"median_amount":3586.02,"10th_percentile":3586.02,"90th_percentile":3586.02,"count":"1 through 10","methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":7229.13,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":7369.5,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7299.31,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"}]}]},{"description":"HC CL TRT DISL STERCLAV WO MANI","code_information":[{"code":"23520","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":1366.82,"maximum":1366.82,"gross_charge":1502,"discounted_cash":707.57,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1366.82,"methodology":"fee schedule"}]}]},{"description":"HC CL TRT DISL STERCLAV WO MANI","code_information":[{"code":"23520","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":352.82,"maximum":3144.74,"gross_charge":1502,"discounted_cash":707.57,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":946.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":946.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":946.26,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2152,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":1821,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":3144.74,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":946.26,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":946.26,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1366.82,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":720.96,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":1126.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":405.54,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":425.82,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":397.43,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":352.82,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":413.66,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":417.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1619.54,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":1572.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1572.37,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":1650.99,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1635.26,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":1572.37,"methodology":"case rate"}]}]},{"description":"HC CL TRT DISL STERCLAV W MANI","code_information":[{"code":"23525","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":1654.38,"maximum":1654.38,"gross_charge":1818,"discounted_cash":856.43,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1654.38,"methodology":"fee schedule"}]}]},{"description":"HC CL TRT DISL STERCLAV W MANI","code_information":[{"code":"23525","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":235.68,"maximum":2152,"gross_charge":1818,"discounted_cash":856.43,"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":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2152,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":1821,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":471.36,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1145.34,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":1145.34,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1654.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":872.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":1363.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":490.86,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":515.41,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":481.05,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":427.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":500.68,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":505.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":242.75,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":235.68,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":235.68,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":247.46,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":245.11,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":235.68,"methodology":"case rate"}]}]},{"description":"TREAT CLAVICLE DISLOCATION","code_information":[{"code":"23530","type":"CPT"}],"standard_charges":[{"minimum":2657.78,"maximum":14037.14,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":3796,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3212,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":14037.14,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":2657.78,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":7229.13,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":7369.5,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7299.31,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"}]}]},{"description":"TREAT CLAVICLE DISLOCATION","code_information":[{"code":"23532","type":"CPT"}],"standard_charges":[{"minimum":3078.06,"maximum":14037.14,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":4157,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3517,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":14037.14,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":3078.06,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":7229.13,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":7369.5,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7299.31,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"}]}]},{"description":"HC CL TRT DISL ACRMCLAV WO MAN","code_information":[{"code":"23540","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":480.48,"maximum":480.48,"gross_charge":528,"discounted_cash":248.74,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":480.48,"methodology":"fee schedule"}]}]},{"description":"HC CL TRT DISL ACRMCLAV WO MAN","code_information":[{"code":"23540","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":124.03,"maximum":2152,"gross_charge":528,"discounted_cash":248.74,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":332.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":332.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":332.64,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2152,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":1821,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":471.36,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":332.64,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":332.64,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":480.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":253.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":396,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":142.56,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":149.69,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":139.71,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":124.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":145.42,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":146.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":242.75,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":235.68,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":235.68,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":247.46,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":245.11,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":235.68,"methodology":"case rate"}]}]},{"description":"HC CL TRT DISL ACRMCLAV W/MANI","code_information":[{"code":"23545","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":1432.34,"maximum":1432.34,"gross_charge":1574,"discounted_cash":741.49,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1432.34,"methodology":"fee schedule"}]}]},{"description":"HC CL TRT DISL ACRMCLAV W/MANI","code_information":[{"code":"23545","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":235.68,"maximum":2152,"gross_charge":1574,"discounted_cash":741.49,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":991.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":991.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":991.62,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2152,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":1821,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":471.36,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":991.62,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":991.62,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1432.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":755.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":1180.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":424.98,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":446.23,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":416.49,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":369.74,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":433.48,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":437.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":242.75,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":235.68,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":235.68,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":247.46,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":245.11,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":235.68,"methodology":"case rate"}]}]},{"description":"TREAT CLAVICLE DISLOCATION","code_information":[{"code":"23550","type":"CPT"}],"standard_charges":[{"minimum":2657.78,"maximum":14037.14,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":3796,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3212,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":14037.14,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":2657.78,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":7229.13,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":7369.5,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7299.31,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"}]}]},{"description":"TREAT CLAVICLE DISLOCATION","code_information":[{"code":"23552","type":"CPT"}],"standard_charges":[{"minimum":3078.06,"maximum":14037.14,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":4157,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3517,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":14037.14,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":3078.06,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":7229.13,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":7369.5,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7299.31,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"}]}]},{"description":"HC CL TRT FX SCAP WO MANIP","code_information":[{"code":"23570","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":480.48,"maximum":480.48,"gross_charge":528,"discounted_cash":248.74,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":480.48,"methodology":"fee schedule"}]}]},{"description":"HC CL TRT FX SCAP WO MANIP","code_information":[{"code":"23570","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":124.03,"maximum":2152,"gross_charge":528,"discounted_cash":248.74,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":332.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":332.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":332.64,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2152,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":1821,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":471.36,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":332.64,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":332.64,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":480.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":253.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":396,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":142.56,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":149.69,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":139.71,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":124.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":145.42,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":146.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":242.75,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":235.68,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":235.68,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":247.46,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":245.11,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":235.68,"methodology":"case rate"}]}]},{"description":"HC CL TRT FX SCAP W/MANIP","code_information":[{"code":"23575","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":552.37,"maximum":552.37,"gross_charge":607,"discounted_cash":285.95,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":552.37,"methodology":"fee schedule"}]}]},{"description":"HC CL TRT FX SCAP W/MANIP","code_information":[{"code":"23575","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":142.59,"maximum":3144.74,"gross_charge":607,"discounted_cash":285.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":382.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":382.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":382.41,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2152,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":1821,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":3144.74,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":382.41,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":382.41,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":552.37,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":291.36,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":455.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":163.89,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":172.09,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":160.62,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":142.59,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":167.17,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":168.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1619.54,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":1572.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1572.37,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":1650.99,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1635.26,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":1572.37,"methodology":"case rate"}]}]},{"description":"TREAT SCAPULA FRACTURE","code_information":[{"code":"23585","type":"CPT"}],"standard_charges":[{"minimum":2657.78,"maximum":14037.14,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":3796,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3212,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":14037.14,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":2657.78,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":7229.13,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":7369.5,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7299.31,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"}]}]},{"description":"CORONARY BYPASS WITHOUT CARDIAC CATHETERIZATION WITHOUT MCC","code_information":[{"code":"236","type":"MS-DRG"}],"standard_charges":[{"minimum":25026.25,"maximum":64749,"setting":"inpatient","payers_information":[{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":61916,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":64749,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":58540.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":25948,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":25948,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":51461,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":60851,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":56130,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":25026.25,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":29197.29,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":27806.94,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":28363.08,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":28363.08,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":28363.08,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":30148.58,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":29416.82,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":29270.46,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":30733.99,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":30002.23,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":29270.46,"methodology":"case rate"}]}]},{"description":"HC CL TX PROX HUM FX WO MANP","code_information":[{"code":"23600","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":480.48,"maximum":480.48,"gross_charge":528,"discounted_cash":248.74,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":480.48,"methodology":"fee schedule"}]}]},{"description":"HC CL TX PROX HUM FX WO MANP","code_information":[{"code":"23600","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":124.03,"maximum":1538.38,"gross_charge":528,"discounted_cash":248.74,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":332.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":332.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":332.64,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":279.84,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":248.16,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":471.36,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":332.64,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":332.64,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":480.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":253.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":396,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":142.56,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":149.69,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":139.71,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":124.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":145.42,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":146.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":242.75,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":235.68,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":235.68,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":247.46,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":245.11,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":235.68,"methodology":"case rate"}]}]},{"description":"HC CL TX PROX HUM FX W MANP","code_information":[{"code":"23605","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":710.71,"maximum":710.71,"gross_charge":781,"discounted_cash":367.92,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":710.71,"methodology":"fee schedule"}]}]},{"description":"HC CL TX PROX HUM FX W MANP","code_information":[{"code":"23605","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":183.46,"maximum":3144.74,"gross_charge":781,"discounted_cash":367.92,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":492.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":492.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":492.03,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2376,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":2011,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":3144.74,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":492.03,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":492.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1923.63,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":710.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":374.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":585.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":210.87,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":221.42,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":206.66,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":183.46,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":215.09,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":217.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1619.54,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":1572.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1572.37,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":1650.99,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1635.26,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":1572.37,"methodology":"case rate"}]}]},{"description":"TREAT HUMERUS FRACTURE","code_information":[{"code":"23615","type":"CPT"}],"standard_charges":[{"minimum":3078.06,"maximum":25282.78,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":4157,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3517,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":25282.78,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":3078.06,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":13020.63,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":12641.39,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":12641.39,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":13273.46,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":13147.05,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":12641.39,"methodology":"case rate"}]}]},{"description":"TREAT HUMERUS FRACTURE","code_information":[{"code":"23616","type":"CPT"}],"standard_charges":[{"minimum":3078.06,"maximum":36135.72,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":4157,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3517,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":36135.72,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":3078.06,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":18609.9,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":18067.86,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":18067.86,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":18971.25,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":18790.57,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":18067.86,"methodology":"case rate"}]}]},{"description":"HC CL TRT FX GR HUM TUB WO MAN","code_information":[{"code":"23620","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":480.48,"maximum":480.48,"gross_charge":528,"discounted_cash":248.74,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":480.48,"methodology":"fee schedule"}]}]},{"description":"HC CL TRT FX GR HUM TUB WO MAN","code_information":[{"code":"23620","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":124.03,"maximum":1538.38,"gross_charge":528,"discounted_cash":248.74,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":332.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":332.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":332.64,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":279.84,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":248.16,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":471.36,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":332.64,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":332.64,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":480.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":253.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":396,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":142.56,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":149.69,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":139.71,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":124.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":145.42,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":146.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":242.75,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":235.68,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":235.68,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":247.46,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":245.11,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":235.68,"methodology":"case rate"}]}]},{"description":"HC CL TX GR TUBEROSITY FX; W MANIP","code_information":[{"code":"23625","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":3019.38,"maximum":3019.38,"gross_charge":3318,"discounted_cash":1563.06,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3019.38,"methodology":"fee schedule"}]}]},{"description":"HC CL TX GR TUBEROSITY FX; W MANIP","code_information":[{"code":"23625","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":779.4,"maximum":3144.74,"gross_charge":3318,"discounted_cash":1563.06,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2090.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2090.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2090.34,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2376,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":2011,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":3144.74,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2090.34,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2090.34,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1923.63,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3019.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1592.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":2488.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":895.86,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":940.66,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":877.95,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":779.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":913.78,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":922.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1619.54,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":1572.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1572.37,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":1650.99,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1635.26,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":1572.37,"methodology":"case rate"}]}]},{"description":"TREAT HUMERUS FRACTURE","code_information":[{"code":"23630","type":"CPT"}],"standard_charges":[{"minimum":3497.02,"maximum":14037.14,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":4514,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3819,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":14037.14,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":3497.02,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":7229.13,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":7369.5,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7299.31,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"}]}]},{"description":"HC CL TX SHLDR DISL WO ANES","code_information":[{"code":"23650","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":674.31,"maximum":674.31,"gross_charge":741,"discounted_cash":349.08,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":674.31,"methodology":"fee schedule"}]}]},{"description":"HC CL TX SHLDR DISL WO ANES","code_information":[{"code":"23650","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":174.07,"maximum":2152,"gross_charge":741,"discounted_cash":349.08,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":466.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":466.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":466.83,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2152,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":1821,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":471.36,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":466.83,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":466.83,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":674.31,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":355.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":555.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":200.07,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":210.08,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":196.07,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":174.07,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":204.08,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":206.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":242.75,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":235.68,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":235.68,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":247.46,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":245.11,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":235.68,"methodology":"case rate"}]}]},{"description":"HC CL TX SHLDR DISL W ANES","code_information":[{"code":"23655","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":3169.53,"maximum":3169.53,"gross_charge":3483,"discounted_cash":1640.79,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3169.53,"methodology":"fee schedule"}]}]},{"description":"HC CL TX SHLDR DISL W ANES","code_information":[{"code":"23655","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":818.16,"maximum":3169.53,"gross_charge":3483,"discounted_cash":1640.79,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2194.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2194.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2194.29,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2152,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":1821,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":3144.74,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2194.29,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2194.29,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3169.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1671.84,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":2612.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":940.41,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":987.44,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":921.61,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":818.16,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":959.22,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":968.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1619.54,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":1572.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1572.37,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":1650.99,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1635.26,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":1572.37,"methodology":"case rate"}]}]},{"description":"TREAT SHOULDER DISLOCATION","code_information":[{"code":"23660","type":"CPT"}],"standard_charges":[{"minimum":2657.78,"maximum":14037.14,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":3796,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3212,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":14037.14,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":2657.78,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":7229.13,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":7369.5,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7299.31,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"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":2120.3,"maximum":2120.3,"gross_charge":2330,"discounted_cash":1097.63,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2120.3,"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":547.32,"maximum":3144.74,"gross_charge":2330,"discounted_cash":1097.63,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1467.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1467.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1467.9,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2376,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":2011,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":3144.74,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1467.9,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":1467.9,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1923.63,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2120.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1118.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":1747.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":629.1,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":660.56,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":616.52,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":547.32,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":641.69,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":647.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1619.54,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":1572.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1572.37,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":1650.99,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1635.26,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":1572.37,"methodology":"case rate"}]}]},{"description":"HC OPEN TX OF SHOULDER DISLOCATION","code_information":[{"code":"23670","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":4239.69,"maximum":4239.69,"gross_charge":4659,"discounted_cash":2194.78,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4239.69,"methodology":"fee schedule"}]}]},{"description":"HC OPEN TX OF SHOULDER DISLOCATION","code_information":[{"code":"23670","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":1094.4,"maximum":14037.14,"gross_charge":4659,"discounted_cash":2194.78,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2935.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2935.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2935.17,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":3796,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3212,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":14037.14,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2935.17,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2935.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2657.78,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4239.69,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2236.32,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":3494.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":1257.93,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":1320.83,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":1232.78,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":1094.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1283.09,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1295.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":7229.13,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":7369.5,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7299.31,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"}]}]},{"description":"HC TREAT DISL/FRACTURE W/MINI","code_information":[{"code":"23675","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":488.67,"maximum":488.67,"gross_charge":537,"discounted_cash":252.98,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":488.67,"methodology":"fee schedule"}]}]},{"description":"HC TREAT DISL/FRACTURE W/MINI","code_information":[{"code":"23675","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":126.15,"maximum":3144.74,"gross_charge":537,"discounted_cash":252.98,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":338.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":338.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":338.31,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2376,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":2011,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":3144.74,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":338.31,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":338.31,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1923.63,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":488.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":257.76,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":402.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":144.99,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":152.24,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":142.1,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":126.15,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":147.89,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":149.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1619.54,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":1572.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1572.37,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":1650.99,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1635.26,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":1572.37,"methodology":"case rate"}]}]},{"description":"TREAT DISLOCATION/FRACTURE","code_information":[{"code":"23680","type":"CPT"}],"standard_charges":[{"minimum":2657.78,"maximum":25282.78,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":3796,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3212,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":25282.78,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":2657.78,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":13020.63,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":12641.39,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":12641.39,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":13273.46,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":13147.05,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":12641.39,"methodology":"case rate"}]}]},{"description":"FIXATION OF SHOULDER","code_information":[{"code":"23700","type":"CPT"}],"standard_charges":[{"minimum":1538.38,"maximum":3144.74,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2152,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":1821,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":3144.74,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1619.54,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":1572.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1572.37,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":1650.99,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1635.26,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":1572.37,"methodology":"case rate"}]}]},{"description":"NO ACTIVE CODE DESCRIPTION","code_information":[{"code":"238","type":"MS-DRG"}],"standard_charges":[{"minimum":23292,"maximum":23292,"setting":"inpatient","payers_information":[{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":23292,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":23292,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"FUSION OF SHOULDER JOINT","code_information":[{"code":"23800","type":"CPT"}],"standard_charges":[{"minimum":3078.06,"maximum":14037.14,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":4157,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3517,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":14037.14,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":3078.06,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":7229.13,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":7369.5,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7299.31,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"}]}]},{"description":"FUSION OF SHOULDER JOINT","code_information":[{"code":"23802","type":"CPT"}],"standard_charges":[{"minimum":4336.27,"maximum":25282.78,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":5489,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":4645,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":25282.78,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":4336.27,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":13020.63,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":12641.39,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":12641.39,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":13273.46,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":13147.05,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":12641.39,"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":30588.69,"maximum":75841,"setting":"inpatient","payers_information":[{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":75841,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":67817,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":71552.48,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":63035,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":74536,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":68754,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":30588.69,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":35686.81,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":33987.43,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":34667.18,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":34667.18,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":34667.18,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":36849.53,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":35955.13,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":35776.24,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":37565.06,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":36670.65,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":35776.24,"methodology":"case rate"}]}]},{"description":"AMPUTATION OF ARM  GIRDLE","code_information":[{"code":"23900","type":"CPT"}],"standard_charges":[{"minimum":3078.06,"maximum":3078.06,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"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|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":3078.06,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"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":3917.28,"maximum":3917.28,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"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|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":3917.28,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"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":1797.18,"maximum":3796,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":3796,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3212,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":3594.36,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":2657.78,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1851.1,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":1797.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1797.18,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":1887.04,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1869.07,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":1797.18,"methodology":"case rate"}]}]},{"description":"SHOULDER SURGERY PROCEDURE","code_information":[{"code":"23929","type":"CPT"}],"standard_charges":[{"minimum":235.68,"maximum":2152,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2152,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":1821,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":471.36,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":242.75,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":235.68,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":235.68,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":247.46,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":245.11,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":235.68,"methodology":"case rate"}]}]},{"description":"DRAINAGE OF ARM LESION","code_information":[{"code":"23930","type":"CPT"}],"standard_charges":[{"minimum":1538.38,"maximum":5623.82,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2152,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":1821,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":5623.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2896.27,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":2811.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2811.91,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":2952.51,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2924.39,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":2811.91,"methodology":"case rate"}]}]},{"description":"HC I&D UPPER ARM/ELBOW BURSA","code_information":[{"code":"23931","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":2428.79,"maximum":2428.79,"gross_charge":2669,"discounted_cash":1257.33,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2428.79,"methodology":"fee schedule"}]}]},{"description":"HC I&D UPPER ARM/ELBOW BURSA","code_information":[{"code":"23931","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":626.95,"maximum":3183.7,"gross_charge":2669,"discounted_cash":1257.33,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1681.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1681.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1681.47,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2376,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":2011,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":3183.7,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1681.47,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":1681.47,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1923.63,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2428.79,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1281.12,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":2001.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":720.63,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":756.67,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":706.22,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":626.95,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":735.05,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":742.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1639.61,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":1591.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1591.85,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":1671.44,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1655.52,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":1591.85,"methodology":"case rate"}]}]},{"description":"DRAIN ARM/ELBOW BONE LESION","code_information":[{"code":"23935","type":"CPT"}],"standard_charges":[{"minimum":1923.63,"maximum":6375.52,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2376,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":2011,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":6375.52,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1923.63,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3283.39,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":3187.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3187.76,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":3347.15,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3315.27,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":3187.76,"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":17809.16,"maximum":43849,"setting":"inpatient","payers_information":[{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":43849,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":39210,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":41658.84,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":36445,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":43095,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":39752,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":17809.16,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":20777.35,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":19787.95,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":20183.71,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":20183.71,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":20183.71,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":21454.31,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":20933.57,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":20829.42,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":21870.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":21350.16,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":20829.42,"methodology":"case rate"}]}]},{"description":"EXPLORATORY ELBOW SURGERY","code_information":[{"code":"24000","type":"CPT"}],"standard_charges":[{"minimum":3078.06,"maximum":6375.52,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":4157,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3517,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":6375.52,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":3078.06,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3283.39,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":3187.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3187.76,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":3347.15,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3315.27,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":3187.76,"methodology":"case rate"}]}]},{"description":"RELEASE ELBOW JOINT","code_information":[{"code":"24006","type":"CPT"}],"standard_charges":[{"minimum":3078.06,"maximum":6375.52,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":4157,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3517,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":6375.52,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":3078.06,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3283.39,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":3187.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3187.76,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":3347.15,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3315.27,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":3187.76,"methodology":"case rate"}]}]},{"description":"BIOPSY ARM/ELBOW SOFT TISSUE","code_information":[{"code":"24065","type":"CPT"}],"standard_charges":[{"minimum":1538.38,"maximum":3183.7,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":3183.7,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1639.61,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":1591.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1591.85,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":1671.44,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1655.52,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":1591.85,"methodology":"case rate"}]}]},{"description":"BIOPSY ARM/ELBOW SOFT TISSUE","code_information":[{"code":"24066","type":"CPT"}],"standard_charges":[{"minimum":1923.63,"maximum":5623.82,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2376,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":2011,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":5623.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1923.63,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2896.27,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":2811.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2811.91,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":2952.51,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2924.39,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":2811.91,"methodology":"case rate"}]}]},{"description":"EXC ARM/ELBOW LES SC 3 CM/>","code_information":[{"code":"24071","type":"CPT"}],"standard_charges":[{"minimum":1538.38,"maximum":5623.82,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2376,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":2011,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":5623.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"median_amount":1634.34,"10th_percentile":1634.34,"90th_percentile":1634.34,"count":"1 through 10","methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2896.27,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":2811.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2811.91,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":2952.51,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2924.39,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":2811.91,"methodology":"case rate"}]}]},{"description":"EX ARM/ELBOW TUM DEEP 5 CM/>","code_information":[{"code":"24073","type":"CPT"}],"standard_charges":[{"minimum":1538.38,"maximum":5623.82,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2376,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":2011,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":5623.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2896.27,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":2811.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2811.91,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":2952.51,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2924.39,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":2811.91,"methodology":"case rate"}]}]},{"description":"EXC ARM/ELBOW LES SC < 3 CM","code_information":[{"code":"24075","type":"CPT"}],"standard_charges":[{"minimum":1591.85,"maximum":3183.7,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2376,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":2011,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":3183.7,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1923.63,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1639.61,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":1591.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1591.85,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":1671.44,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1655.52,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":1591.85,"methodology":"case rate"}]}]},{"description":"EX ARM/ELBOW TUM DEEP < 5 CM","code_information":[{"code":"24076","type":"CPT"}],"standard_charges":[{"minimum":1923.63,"maximum":5623.82,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2376,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":2011,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":5623.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1923.63,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2896.27,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":2811.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2811.91,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":2952.51,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2924.39,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":2811.91,"methodology":"case rate"}]}]},{"description":"RESECT ARM/ELBOW TUM < 5 CM","code_information":[{"code":"24077","type":"CPT"}],"standard_charges":[{"minimum":2657.78,"maximum":5623.82,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":3796,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3212,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":5623.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":2657.78,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2896.27,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":2811.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2811.91,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":2952.51,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2924.39,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":2811.91,"methodology":"case rate"}]}]},{"description":"RESECT ARM/ELBOW TUM 5 CM/>","code_information":[{"code":"24079","type":"CPT"}],"standard_charges":[{"minimum":1538.38,"maximum":5623.82,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":5623.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2896.27,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":2811.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2811.91,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":2952.51,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2924.39,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":2811.91,"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":9374.68,"maximum":22735,"setting":"inpatient","payers_information":[{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":22735,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":20329,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":21929.06,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":18896,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":22344,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":20610,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":9374.68,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":10937.13,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":10416.31,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":10624.64,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":10624.64,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":10624.64,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":11293.47,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":11019.36,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":10964.53,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":11512.76,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":11238.65,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":10964.53,"methodology":"case rate"}]}]},{"description":"BIOPSY ELBOW JOINT LINING","code_information":[{"code":"24100","type":"CPT"}],"standard_charges":[{"minimum":1538.38,"maximum":6375.52,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2152,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":1821,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":6375.52,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3283.39,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":3187.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3187.76,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":3347.15,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3315.27,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":3187.76,"methodology":"case rate"}]}]},{"description":"EXPLORE/TREAT ELBOW JOINT","code_information":[{"code":"24101","type":"CPT"}],"standard_charges":[{"minimum":3078.06,"maximum":6375.52,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":4157,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3517,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":6375.52,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":3078.06,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3283.39,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":3187.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3187.76,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":3347.15,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3315.27,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":3187.76,"methodology":"case rate"}]}]},{"description":"REMOVE ELBOW JOINT LINING","code_information":[{"code":"24102","type":"CPT"}],"standard_charges":[{"minimum":3078.06,"maximum":6375.52,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":4157,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3517,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":6375.52,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":3078.06,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3283.39,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":3187.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3187.76,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":3347.15,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3315.27,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":3187.76,"methodology":"case rate"}]}]},{"description":"REMOVAL OF ELBOW BURSA","code_information":[{"code":"24105","type":"CPT"}],"standard_charges":[{"minimum":2657.78,"maximum":6375.52,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":3796,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3212,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":6375.52,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":2657.78,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3283.39,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":3187.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3187.76,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":3347.15,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3315.27,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":3187.76,"methodology":"case rate"}]}]},{"description":"REMOVE HUMERUS LESION","code_information":[{"code":"24110","type":"CPT"}],"standard_charges":[{"minimum":1923.63,"maximum":6375.52,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2376,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":2011,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":6375.52,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1923.63,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3283.39,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":3187.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3187.76,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":3347.15,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3315.27,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":3187.76,"methodology":"case rate"}]}]},{"description":"REMOVE/GRAFT BONE LESION","code_information":[{"code":"24115","type":"CPT"}],"standard_charges":[{"minimum":2657.78,"maximum":14037.14,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":3796,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3212,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":14037.14,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":2657.78,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":7229.13,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":7369.5,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7299.31,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"}]}]},{"description":"REMOVE/GRAFT BONE LESION","code_information":[{"code":"24116","type":"CPT"}],"standard_charges":[{"minimum":2657.78,"maximum":14037.14,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":3796,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3212,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":14037.14,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":2657.78,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":7229.13,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":7369.5,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7299.31,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"}]}]},{"description":"REMOVE ELBOW LESION","code_information":[{"code":"24120","type":"CPT"}],"standard_charges":[{"minimum":2657.78,"maximum":6375.52,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":3796,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3212,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":6375.52,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":2657.78,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3283.39,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":3187.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3187.76,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":3347.15,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3315.27,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":3187.76,"methodology":"case rate"}]}]},{"description":"REMOVE/GRAFT BONE LESION","code_information":[{"code":"24125","type":"CPT"}],"standard_charges":[{"minimum":2657.78,"maximum":6375.52,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":3796,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3212,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":6375.52,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":2657.78,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3283.39,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":3187.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3187.76,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":3347.15,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3315.27,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":3187.76,"methodology":"case rate"}]}]},{"description":"REMOVE/GRAFT BONE LESION","code_information":[{"code":"24126","type":"CPT"}],"standard_charges":[{"minimum":2657.78,"maximum":14037.14,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":3796,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3212,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":14037.14,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":2657.78,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":7229.13,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":7369.5,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7299.31,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"}]}]},{"description":"REMOVAL OF HEAD OF RADIUS","code_information":[{"code":"24130","type":"CPT"}],"standard_charges":[{"minimum":2657.78,"maximum":6375.52,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":3796,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3212,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":6375.52,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":2657.78,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3283.39,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":3187.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3187.76,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":3347.15,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3315.27,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":3187.76,"methodology":"case rate"}]}]},{"description":"REMOVAL OF ARM BONE LESION","code_information":[{"code":"24134","type":"CPT"}],"standard_charges":[{"minimum":1923.63,"maximum":14037.14,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2376,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":2011,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":14037.14,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1923.63,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":7229.13,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":7369.5,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7299.31,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"}]}]},{"description":"REMOVE RADIUS BONE LESION","code_information":[{"code":"24136","type":"CPT"}],"standard_charges":[{"minimum":1923.63,"maximum":6375.52,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2376,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":2011,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":6375.52,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1923.63,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3283.39,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":3187.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3187.76,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":3347.15,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3315.27,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":3187.76,"methodology":"case rate"}]}]},{"description":"REMOVE ELBOW BONE LESION","code_information":[{"code":"24138","type":"CPT"}],"standard_charges":[{"minimum":1923.63,"maximum":14037.14,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2376,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":2011,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":14037.14,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1923.63,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":7229.13,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":7369.5,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7299.31,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"}]}]},{"description":"PARTIAL REMOVAL OF ARM BONE","code_information":[{"code":"24140","type":"CPT"}],"standard_charges":[{"minimum":2657.78,"maximum":6375.52,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":3796,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3212,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":6375.52,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":2657.78,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3283.39,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":3187.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3187.76,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":3347.15,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3315.27,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":3187.76,"methodology":"case rate"}]}]},{"description":"PARTIAL REMOVAL OF RADIUS","code_information":[{"code":"24145","type":"CPT"}],"standard_charges":[{"minimum":2657.78,"maximum":14037.14,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":3796,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3212,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":14037.14,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":2657.78,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":7229.13,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":7369.5,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7299.31,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"}]}]},{"description":"PARTIAL REMOVAL OF ELBOW","code_information":[{"code":"24147","type":"CPT"}],"standard_charges":[{"minimum":1923.63,"maximum":6375.52,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2376,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":2011,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":6375.52,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1923.63,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3283.39,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":3187.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3187.76,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":3347.15,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3315.27,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":3187.76,"methodology":"case rate"}]}]},{"description":"RADICAL RESECTION OF ELBOW","code_information":[{"code":"24149","type":"CPT"}],"standard_charges":[{"minimum":1923.63,"maximum":14037.14,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":14037.14,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1923.63,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":7229.13,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":7369.5,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7299.31,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"}]}]},{"description":"RESECT DISTAL HUMERUS TUMOR","code_information":[{"code":"24150","type":"CPT"}],"standard_charges":[{"minimum":4266.22,"maximum":14037.14,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":14037.14,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":4266.22,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":7229.13,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":7369.5,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7299.31,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"}]}]},{"description":"RESECT RADIUS TUMOR","code_information":[{"code":"24152","type":"CPT"}],"standard_charges":[{"minimum":3819,"maximum":14037.14,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":4514,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3819,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":14037.14,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":4266.22,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":7229.13,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":7369.5,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7299.31,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"}]}]},{"description":"REMOVAL OF ELBOW JOINT","code_information":[{"code":"24155","type":"CPT"}],"standard_charges":[{"minimum":2657.78,"maximum":6375.52,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":3796,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3212,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":6375.52,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":2657.78,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3283.39,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":3187.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3187.76,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":3347.15,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3315.27,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":3187.76,"methodology":"case rate"}]}]},{"description":"REMOVE ELBOW JOINT IMPLANT","code_information":[{"code":"24160","type":"CPT"}],"standard_charges":[{"minimum":1923.63,"maximum":6375.52,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2376,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":2011,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":6375.52,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1923.63,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3283.39,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":3187.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3187.76,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":3347.15,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3315.27,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":3187.76,"methodology":"case rate"}]}]},{"description":"REMOVE RADIUS HEAD IMPLANT","code_information":[{"code":"24164","type":"CPT"}],"standard_charges":[{"minimum":2657.78,"maximum":6375.52,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":3796,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3212,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":6375.52,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":2657.78,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3283.39,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":3187.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3187.76,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":3347.15,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3315.27,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":3187.76,"methodology":"case rate"}]}]},{"description":"PERMANENT CARDIAC PACEMAKER IMPLANT WITH MCC","code_information":[{"code":"242","type":"MS-DRG"}],"standard_charges":[{"minimum":20695.04,"maximum":51073,"setting":"inpatient","payers_information":[{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":51073,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":45670,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":48409.42,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":23731,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":23731,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":42449,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":50195,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":46301,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":20695.04,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":24144.21,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":22994.48,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":23454.37,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":23454.37,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":23454.37,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":24930.86,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":24325.74,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":24204.71,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":25414.95,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":24809.83,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":24204.71,"methodology":"case rate"}]}]},{"description":"HC REMOVAL FB ARM/ELBOW SQ","code_information":[{"code":"24200","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":606.06,"maximum":606.06,"gross_charge":666,"discounted_cash":313.75,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":606.06,"methodology":"fee schedule"}]}]},{"description":"HC REMOVAL FB ARM/ELBOW SQ","code_information":[{"code":"24200","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":156.45,"maximum":3183.7,"gross_charge":666,"discounted_cash":313.75,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":419.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":419.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":419.58,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":352.98,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":313.02,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":3183.7,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":419.58,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":419.58,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":606.06,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":319.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":499.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":179.82,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":188.82,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":176.23,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":156.45,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":183.42,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":185.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1639.61,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":1591.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1591.85,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":1671.44,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1655.52,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":1591.85,"methodology":"case rate"}]}]},{"description":"REMOVAL OF ARM FOREIGN BODY","code_information":[{"code":"24201","type":"CPT"}],"standard_charges":[{"minimum":1923.63,"maximum":5623.82,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2376,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":2011,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":5623.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1923.63,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2896.27,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":2811.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2811.91,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":2952.51,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2924.39,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":2811.91,"methodology":"case rate"}]}]},{"description":"HC INJECTION FOR ELBOW XRAY","code_information":[{"code":"24220","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":292.11,"maximum":292.11,"gross_charge":321,"discounted_cash":151.22,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":292.11,"methodology":"fee schedule"}]}]},{"description":"HC INJECTION FOR ELBOW XRAY","code_information":[{"code":"24220","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":75.41,"maximum":1923.63,"gross_charge":321,"discounted_cash":151.22,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":202.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":202.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":202.23,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":202.23,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":202.23,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1923.63,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":292.11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":154.08,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":240.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":86.67,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":91.01,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":84.94,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":75.41,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":88.41,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":89.28,"methodology":"fee schedule"}]}]},{"description":"PERMANENT CARDIAC PACEMAKER IMPLANT WITH CC","code_information":[{"code":"243","type":"MS-DRG"}],"standard_charges":[{"minimum":13843.04,"maximum":33920,"setting":"inpatient","payers_information":[{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":33920,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":30332,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":32381.36,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":23731,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":23731,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":28193,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":33337,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":30751,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":13843.04,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":16150.21,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":15381.15,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":15688.78,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":15688.78,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":15688.78,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":16676.41,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":16271.64,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":16190.68,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":17000.22,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":16595.45,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":16190.68,"methodology":"case rate"}]}]},{"description":"MANIPULATE ELBOW W/ANESTH","code_information":[{"code":"24300","type":"CPT"}],"standard_charges":[{"minimum":1538.38,"maximum":3144.74,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":3144.74,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1619.54,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":1572.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1572.37,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":1650.99,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1635.26,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":1572.37,"methodology":"case rate"}]}]},{"description":"MUSCLE/TENDON TRANSFER","code_information":[{"code":"24301","type":"CPT"}],"standard_charges":[{"minimum":3078.06,"maximum":14037.14,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":4157,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3517,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":14037.14,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":3078.06,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":7229.13,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":7369.5,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7299.31,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"}]}]},{"description":"ARM TENDON LENGTHENING","code_information":[{"code":"24305","type":"CPT"}],"standard_charges":[{"minimum":3078.06,"maximum":6375.52,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":4157,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3517,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":6375.52,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":3078.06,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3283.39,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":3187.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3187.76,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":3347.15,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3315.27,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":3187.76,"methodology":"case rate"}]}]},{"description":"REVISION OF ARM TENDON","code_information":[{"code":"24310","type":"CPT"}],"standard_charges":[{"minimum":2657.78,"maximum":6375.52,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":3796,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3212,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":6375.52,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":2657.78,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3283.39,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":3187.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3187.76,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":3347.15,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3315.27,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":3187.76,"methodology":"case rate"}]}]},{"description":"REPAIR OF ARM TENDON","code_information":[{"code":"24320","type":"CPT"}],"standard_charges":[{"minimum":2657.78,"maximum":14037.14,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":3796,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3212,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":14037.14,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":2657.78,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":7229.13,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":7369.5,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7299.31,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"}]}]},{"description":"REVISION OF ARM MUSCLES","code_information":[{"code":"24330","type":"CPT"}],"standard_charges":[{"minimum":2657.78,"maximum":14037.14,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":3796,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3212,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":14037.14,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":2657.78,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":7229.13,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":7369.5,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7299.31,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"}]}]},{"description":"REVISION OF ARM MUSCLES","code_information":[{"code":"24331","type":"CPT"}],"standard_charges":[{"minimum":2657.78,"maximum":14037.14,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":3796,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3212,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":14037.14,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":2657.78,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":7229.13,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":7369.5,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7299.31,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"}]}]},{"description":"TENOLYSIS TRICEPS","code_information":[{"code":"24332","type":"CPT"}],"standard_charges":[{"minimum":1538.38,"maximum":6375.52,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":6375.52,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3283.39,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":3187.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3187.76,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":3347.15,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3315.27,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":3187.76,"methodology":"case rate"}]}]},{"description":"REPAIR OF BICEPS TENDON","code_information":[{"code":"24340","type":"CPT"}],"standard_charges":[{"minimum":2657.78,"maximum":14037.14,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":3796,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3212,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":14037.14,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":2657.78,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":7229.13,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":7369.5,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7299.31,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"}]}]},{"description":"REPAIR ARM TENDON/MUSCLE","code_information":[{"code":"24341","type":"CPT"}],"standard_charges":[{"minimum":2657.78,"maximum":14037.14,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":3796,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3212,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":14037.14,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":2657.78,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":7229.13,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":7369.5,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7299.31,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"}]}]},{"description":"REPAIR OF RUPTURED TENDON","code_information":[{"code":"24342","type":"CPT"}],"standard_charges":[{"minimum":2657.78,"maximum":14037.14,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":3796,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3212,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":14037.14,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":2657.78,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"median_amount":5957.48,"10th_percentile":5957.48,"90th_percentile":5957.48,"count":"1 through 10","methodology":"percent of total billed charges"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":7229.13,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":7369.5,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7299.31,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"}]}]},{"description":"REPR ELBOW LAT LIGMNT W/TISS","code_information":[{"code":"24343","type":"CPT"}],"standard_charges":[{"minimum":3187.76,"maximum":6375.52,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":6375.52,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":3497.02,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3283.39,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":3187.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3187.76,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":3347.15,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3315.27,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":3187.76,"methodology":"case rate"}]}]},{"description":"RECONSTRUCT ELBOW LAT LIGMNT","code_information":[{"code":"24344","type":"CPT"}],"standard_charges":[{"minimum":4266.22,"maximum":14037.14,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":14037.14,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":4266.22,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":7229.13,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":7369.5,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7299.31,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"}]}]},{"description":"REPR ELBW MED LIGMNT W/TISSU","code_information":[{"code":"24345","type":"CPT"}],"standard_charges":[{"minimum":1923.63,"maximum":14037.14,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2376,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":2011,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":14037.14,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1923.63,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":7229.13,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":7369.5,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7299.31,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"}]}]},{"description":"RECONSTRUCT ELBOW MED LIGMNT","code_information":[{"code":"24346","type":"CPT"}],"standard_charges":[{"minimum":4266.22,"maximum":25282.78,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":25282.78,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":4266.22,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":13020.63,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":12641.39,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":12641.39,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":13273.46,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":13147.05,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":12641.39,"methodology":"case rate"}]}]},{"description":"REPAIR ELBOW PERC","code_information":[{"code":"24357","type":"CPT"}],"standard_charges":[{"minimum":2657.78,"maximum":6375.52,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":3796,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3212,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":6375.52,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":2657.78,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3283.39,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":3187.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3187.76,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":3347.15,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3315.27,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":3187.76,"methodology":"case rate"}]}]},{"description":"REPAIR ELBOW W/DEB OPEN","code_information":[{"code":"24358","type":"CPT"}],"standard_charges":[{"minimum":2657.78,"maximum":6375.52,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":3796,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3212,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":6375.52,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":2657.78,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3283.39,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":3187.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3187.76,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":3347.15,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3315.27,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":3187.76,"methodology":"case rate"}]}]},{"description":"REPAIR ELBOW DEB/ATTCH OPEN","code_information":[{"code":"24359","type":"CPT"}],"standard_charges":[{"minimum":2657.78,"maximum":6375.52,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":3796,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3212,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":6375.52,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":2657.78,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3283.39,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":3187.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3187.76,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":3347.15,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3315.27,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":3187.76,"methodology":"case rate"}]}]},{"description":"RECONSTRUCT ELBOW JOINT","code_information":[{"code":"24360","type":"CPT"}],"standard_charges":[{"minimum":3497.02,"maximum":14037.14,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":4514,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3819,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":14037.14,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":3497.02,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":7229.13,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":7369.5,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7299.31,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"}]}]},{"description":"RECONSTRUCT ELBOW JOINT","code_information":[{"code":"24361","type":"CPT"}],"standard_charges":[{"minimum":3497.02,"maximum":36135.72,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":4514,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3819,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":36135.72,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":3497.02,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":18609.9,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":18067.86,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":18067.86,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":18971.25,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":18790.57,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":18067.86,"methodology":"case rate"}]}]},{"description":"RECONSTRUCT ELBOW JOINT","code_information":[{"code":"24362","type":"CPT"}],"standard_charges":[{"minimum":3497.02,"maximum":25282.78,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":4514,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3819,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":25282.78,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":3497.02,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":13020.63,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":12641.39,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":12641.39,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":13273.46,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":13147.05,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":12641.39,"methodology":"case rate"}]}]},{"description":"REPLACE ELBOW JOINT","code_information":[{"code":"24363","type":"CPT"}],"standard_charges":[{"minimum":4336.27,"maximum":36135.72,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":5489,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":4645,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":36135.72,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":4336.27,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":18609.9,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":18067.86,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":18067.86,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":18971.25,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":18790.57,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":18067.86,"methodology":"case rate"}]}]},{"description":"RECONSTRUCT HEAD OF RADIUS","code_information":[{"code":"24365","type":"CPT"}],"standard_charges":[{"minimum":3497.02,"maximum":25282.78,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":4514,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3819,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":25282.78,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":3497.02,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":13020.63,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":12641.39,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":12641.39,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":13273.46,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":13147.05,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":12641.39,"methodology":"case rate"}]}]},{"description":"RECONSTRUCT HEAD OF RADIUS","code_information":[{"code":"24366","type":"CPT"}],"standard_charges":[{"minimum":3497.02,"maximum":25282.78,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":4514,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3819,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":25282.78,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":3497.02,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":13020.63,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":12641.39,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":12641.39,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":13273.46,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":13147.05,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":12641.39,"methodology":"case rate"}]}]},{"description":"REVISE RECONST ELBOW JOINT","code_information":[{"code":"24370","type":"CPT"}],"standard_charges":[{"minimum":5385.62,"maximum":25282.78,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":25282.78,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":5385.62,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":13020.63,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":12641.39,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":12641.39,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":13273.46,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":13147.05,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":12641.39,"methodology":"case rate"}]}]},{"description":"REVISE RECONST ELBOW JOINT","code_information":[{"code":"24371","type":"CPT"}],"standard_charges":[{"minimum":5385.62,"maximum":36135.72,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":36135.72,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":5385.62,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":18609.9,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":18067.86,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":18067.86,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":18971.25,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":18790.57,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":18067.86,"methodology":"case rate"}]}]},{"description":"PERMANENT CARDIAC PACEMAKER IMPLANT WITHOUT CC/MCC","code_information":[{"code":"244","type":"MS-DRG"}],"standard_charges":[{"minimum":11147.84,"maximum":27173,"setting":"inpatient","payers_information":[{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":27173,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":24298,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":26076.78,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":23731,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":23731,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":22585,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":26706,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":24634,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":11147.84,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":13005.81,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":12386.48,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":12634.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":12634.21,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12634.21,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":13429.55,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":13103.59,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":13038.39,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":13690.31,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":13364.35,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":13038.39,"methodology":"case rate"}]}]},{"description":"REVISION OF HUMERUS","code_information":[{"code":"24400","type":"CPT"}],"standard_charges":[{"minimum":3078.06,"maximum":14037.14,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":4157,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3517,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":14037.14,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":3078.06,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":7229.13,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":7369.5,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7299.31,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"}]}]},{"description":"REVISION OF HUMERUS","code_information":[{"code":"24410","type":"CPT"}],"standard_charges":[{"minimum":3078.06,"maximum":25282.78,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":4157,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3517,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":25282.78,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":3078.06,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":13020.63,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":12641.39,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":12641.39,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":13273.46,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":13147.05,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":12641.39,"methodology":"case rate"}]}]},{"description":"REVISION OF HUMERUS","code_information":[{"code":"24420","type":"CPT"}],"standard_charges":[{"minimum":2657.78,"maximum":14037.14,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":3796,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3212,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":14037.14,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":2657.78,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":7229.13,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":7369.5,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7299.31,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"}]}]},{"description":"REPAIR OF HUMERUS","code_information":[{"code":"24430","type":"CPT"}],"standard_charges":[{"minimum":2657.78,"maximum":25282.78,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":3796,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3212,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":25282.78,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":2657.78,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":13020.63,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":12641.39,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":12641.39,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":13273.46,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":13147.05,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":12641.39,"methodology":"case rate"}]}]},{"description":"REPAIR HUMERUS WITH GRAFT","code_information":[{"code":"24435","type":"CPT"}],"standard_charges":[{"minimum":3078.06,"maximum":25282.78,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":4157,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3517,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":25282.78,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":3078.06,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":13020.63,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":12641.39,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":12641.39,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":13273.46,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":13147.05,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":12641.39,"methodology":"case rate"}]}]},{"description":"REVISION OF ELBOW JOINT","code_information":[{"code":"24470","type":"CPT"}],"standard_charges":[{"minimum":2657.78,"maximum":6375.52,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":3796,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3212,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":6375.52,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":2657.78,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3283.39,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":3187.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3187.76,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":3347.15,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3315.27,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":3187.76,"methodology":"case rate"}]}]},{"description":"DECOMPRESSION OF FOREARM","code_information":[{"code":"24495","type":"CPT"}],"standard_charges":[{"minimum":1923.63,"maximum":14037.14,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2376,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":2011,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":14037.14,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1923.63,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":7229.13,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":7369.5,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7299.31,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"}]}]},{"description":"REINFORCE HUMERUS","code_information":[{"code":"24498","type":"CPT"}],"standard_charges":[{"minimum":2657.78,"maximum":25282.78,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":3796,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3212,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":25282.78,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":2657.78,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":13020.63,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":12641.39,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":12641.39,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":13273.46,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":13147.05,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":12641.39,"methodology":"case rate"}]}]},{"description":"AICD GENERATOR PROCEDURES","code_information":[{"code":"245","type":"MS-DRG"}],"standard_charges":[{"minimum":25115,"maximum":73581,"setting":"inpatient","payers_information":[{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":73581,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":65796,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":69440.62,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":25115,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":25115,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":61156,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":72315,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":66705,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":29685.87,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":34633.52,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":32984.3,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":33643.99,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":33643.99,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":33643.99,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":35761.92,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":34893.92,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":34720.31,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":36456.33,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":35588.32,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":34720.31,"methodology":"case rate"}]}]},{"description":"HC CL TX HUMERAL WO/MANP","code_information":[{"code":"24500","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":480.48,"maximum":480.48,"gross_charge":528,"discounted_cash":248.74,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":480.48,"methodology":"fee schedule"}]}]},{"description":"HC CL TX HUMERAL WO/MANP","code_information":[{"code":"24500","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":124.03,"maximum":2152,"gross_charge":528,"discounted_cash":248.74,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":332.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":332.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":332.64,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2152,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":1821,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":471.36,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":332.64,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":332.64,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":480.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":253.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":396,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":142.56,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":149.69,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":139.71,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":124.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":145.42,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":146.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":242.75,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":235.68,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":235.68,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":247.46,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":245.11,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":235.68,"methodology":"case rate"}]}]},{"description":"HC CL HUMERAL SHAFT W/MANIP","code_information":[{"code":"24505","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":595.14,"maximum":595.14,"gross_charge":654,"discounted_cash":308.09,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":595.14,"methodology":"fee schedule"}]}]},{"description":"HC CL HUMERAL SHAFT W/MANIP","code_information":[{"code":"24505","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":153.63,"maximum":3144.74,"gross_charge":654,"discounted_cash":308.09,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":412.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":412.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":412.02,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2152,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":1821,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":3144.74,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":412.02,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":412.02,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":595.14,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":313.92,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":490.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":176.58,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":185.41,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":173.05,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":153.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":180.12,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":181.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1619.54,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":1572.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1572.37,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":1650.99,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1635.26,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":1572.37,"methodology":"case rate"}]}]},{"description":"TREAT HUMERUS FRACTURE","code_information":[{"code":"24515","type":"CPT"}],"standard_charges":[{"minimum":3078.06,"maximum":25282.78,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":4157,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3517,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":25282.78,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":3078.06,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"median_amount":1358.3,"10th_percentile":1358.3,"90th_percentile":1358.3,"count":"1 through 10","methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":13020.63,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":12641.39,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":12641.39,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":13273.46,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":13147.05,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":12641.39,"methodology":"case rate"}]}]},{"description":"TREAT HUMERUS FRACTURE","code_information":[{"code":"24516","type":"CPT"}],"standard_charges":[{"minimum":3078.06,"maximum":25282.78,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":4157,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3517,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":25282.78,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":3078.06,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":13020.63,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":12641.39,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":12641.39,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":13273.46,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":13147.05,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":12641.39,"methodology":"case rate"}]}]},{"description":"HC CL TX SUP/TRAN WO/MANP","code_information":[{"code":"24530","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":1081.08,"maximum":1081.08,"gross_charge":1188,"discounted_cash":559.65,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1081.08,"methodology":"fee schedule"}]}]},{"description":"HC CL TX SUP/TRAN WO/MANP","code_information":[{"code":"24530","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":235.68,"maximum":2152,"gross_charge":1188,"discounted_cash":559.65,"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 - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2152,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":1821,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":471.36,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":748.44,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":748.44,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1081.08,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":570.24,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":891,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":320.76,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":336.8,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":314.35,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":279.07,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":327.18,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":330.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":242.75,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":235.68,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":235.68,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":247.46,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":245.11,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":235.68,"methodology":"case rate"}]}]},{"description":"HC CL TX SUP/TRAN W/MANP","code_information":[{"code":"24535","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":444.08,"maximum":444.08,"gross_charge":488,"discounted_cash":229.89,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":444.08,"methodology":"fee schedule"}]}]},{"description":"HC CL TX SUP/TRAN W/MANP","code_information":[{"code":"24535","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":114.64,"maximum":3144.74,"gross_charge":488,"discounted_cash":229.89,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":307.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":307.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":307.44,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2152,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":1821,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":3144.74,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":307.44,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":307.44,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":444.08,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":234.24,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":366,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":131.76,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":138.35,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":129.13,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":114.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":134.4,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":135.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1619.54,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":1572.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1572.37,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":1650.99,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1635.26,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":1572.37,"methodology":"case rate"}]}]},{"description":"HC TRT HUM FRAC W/WO INT EXT","code_information":[{"code":"24538","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":4693.78,"maximum":4693.78,"gross_charge":5158,"discounted_cash":2429.85,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4693.78,"methodology":"fee schedule"}]}]},{"description":"HC TRT HUM FRAC W/WO INT EXT","code_information":[{"code":"24538","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":1211.62,"maximum":14037.14,"gross_charge":5158,"discounted_cash":2429.85,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3249.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3249.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3249.54,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2376,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":2011,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":14037.14,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3249.54,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3249.54,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1923.63,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4693.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2475.84,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":3868.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":1392.66,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":1462.3,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":1364.81,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":1211.62,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1420.52,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1434.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":7229.13,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":7369.5,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7299.31,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"}]}]},{"description":"TREAT HUMERUS FRACTURE","code_information":[{"code":"24545","type":"CPT"}],"standard_charges":[{"minimum":3078.06,"maximum":25282.78,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":4157,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3517,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":25282.78,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":3078.06,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":13020.63,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":12641.39,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":12641.39,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":13273.46,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":13147.05,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":12641.39,"methodology":"case rate"}]}]},{"description":"TREAT HUMERUS FRACTURE","code_information":[{"code":"24546","type":"CPT"}],"standard_charges":[{"minimum":3497.02,"maximum":25282.78,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":4514,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3819,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":25282.78,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":3497.02,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":13020.63,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":12641.39,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":12641.39,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":13273.46,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":13147.05,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":12641.39,"methodology":"case rate"}]}]},{"description":"HC CL TRT FX HUM EPIC WO MANIP","code_information":[{"code":"24560","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":480.48,"maximum":480.48,"gross_charge":528,"discounted_cash":248.74,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":480.48,"methodology":"fee schedule"}]}]},{"description":"HC CL TRT FX HUM EPIC WO MANIP","code_information":[{"code":"24560","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":124.03,"maximum":2152,"gross_charge":528,"discounted_cash":248.74,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":332.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":332.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":332.64,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2152,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":1821,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":471.36,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":332.64,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":332.64,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":480.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":253.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":396,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":142.56,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":149.69,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":139.71,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":124.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":145.42,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":146.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":242.75,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":235.68,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":235.68,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":247.46,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":245.11,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":235.68,"methodology":"case rate"}]}]},{"description":"HC CL TRT FX HUM EPIC W/MANIP","code_information":[{"code":"24565","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":477.75,"maximum":477.75,"gross_charge":525,"discounted_cash":247.32,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":477.75,"methodology":"fee schedule"}]}]},{"description":"HC CL TRT FX HUM EPIC W/MANIP","code_information":[{"code":"24565","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":123.33,"maximum":3144.74,"gross_charge":525,"discounted_cash":247.32,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":330.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":330.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":330.75,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2376,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":2011,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":3144.74,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":330.75,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":330.75,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1923.63,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":477.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":252,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":393.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":141.75,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":148.84,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":138.92,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":123.33,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":144.59,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":146.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1619.54,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":1572.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1572.37,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":1650.99,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1635.26,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":1572.37,"methodology":"case rate"}]}]},{"description":"TREAT HUMERUS FRACTURE","code_information":[{"code":"24566","type":"CPT"}],"standard_charges":[{"minimum":1572.37,"maximum":3144.74,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2376,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":2011,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":3144.74,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1923.63,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1619.54,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":1572.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1572.37,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":1650.99,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1635.26,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":1572.37,"methodology":"case rate"}]}]},{"description":"TREAT HUMERUS FRACTURE","code_information":[{"code":"24575","type":"CPT"}],"standard_charges":[{"minimum":2657.78,"maximum":25282.78,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":3796,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3212,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":25282.78,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":2657.78,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":13020.63,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":12641.39,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":12641.39,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":13273.46,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":13147.05,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":12641.39,"methodology":"case rate"}]}]},{"description":"HC CL TRT FX HUM CN MED/LAT WO M","code_information":[{"code":"24576","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":480.48,"maximum":480.48,"gross_charge":528,"discounted_cash":248.74,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":480.48,"methodology":"fee schedule"}]}]},{"description":"HC CL TRT FX HUM CN MED/LAT WO M","code_information":[{"code":"24576","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":124.03,"maximum":2152,"gross_charge":528,"discounted_cash":248.74,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":332.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":332.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":332.64,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2152,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":1821,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":471.36,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":332.64,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":332.64,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":480.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":253.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":396,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":142.56,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":149.69,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":139.71,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":124.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":145.42,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":146.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":242.75,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":235.68,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":235.68,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":247.46,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":245.11,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":235.68,"methodology":"case rate"}]}]},{"description":"HC CL TRT FX HUM CN MED/LAT W/MA","code_information":[{"code":"24577","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":526.89,"maximum":526.89,"gross_charge":579,"discounted_cash":272.76,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":526.89,"methodology":"fee schedule"}]}]},{"description":"HC CL TRT FX HUM CN MED/LAT W/MA","code_information":[{"code":"24577","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":136.01,"maximum":3144.74,"gross_charge":579,"discounted_cash":272.76,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":364.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":364.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":364.77,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2152,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":1821,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":3144.74,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":364.77,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":364.77,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":526.89,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":277.92,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":434.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":156.33,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":164.15,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":153.21,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":136.01,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":159.46,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":161.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1619.54,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":1572.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1572.37,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":1650.99,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1635.26,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":1572.37,"methodology":"case rate"}]}]},{"description":"TREAT HUMERUS FRACTURE","code_information":[{"code":"24579","type":"CPT"}],"standard_charges":[{"minimum":2657.78,"maximum":25282.78,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":3796,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3212,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":25282.78,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":2657.78,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":13020.63,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":12641.39,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":12641.39,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":13273.46,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":13147.05,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":12641.39,"methodology":"case rate"}]}]},{"description":"TREAT HUMERUS FRACTURE","code_information":[{"code":"24582","type":"CPT"}],"standard_charges":[{"minimum":1923.63,"maximum":14037.14,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2376,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":2011,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":14037.14,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1923.63,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":7229.13,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":7369.5,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7299.31,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"}]}]},{"description":"TREAT ELBOW FRACTURE","code_information":[{"code":"24586","type":"CPT"}],"standard_charges":[{"minimum":3078.06,"maximum":25282.78,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":4157,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3517,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":25282.78,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":3078.06,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":13020.63,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":12641.39,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":12641.39,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":13273.46,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":13147.05,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":12641.39,"methodology":"case rate"}]}]},{"description":"TREAT ELBOW FRACTURE","code_information":[{"code":"24587","type":"CPT"}],"standard_charges":[{"minimum":3497.02,"maximum":25282.78,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":4514,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3819,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":25282.78,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":3497.02,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":13020.63,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":12641.39,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":12641.39,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":13273.46,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":13147.05,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":12641.39,"methodology":"case rate"}]}]},{"description":"NO ACTIVE CODE DESCRIPTION","code_information":[{"code":"246","type":"MS-DRG"}],"standard_charges":[{"minimum":20088,"maximum":20088,"setting":"inpatient","payers_information":[{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":20088,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":20088,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC CL TX ELBOW DIS WO/ANES","code_information":[{"code":"24600","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":480.48,"maximum":480.48,"gross_charge":528,"discounted_cash":248.74,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":480.48,"methodology":"fee schedule"}]}]},{"description":"HC CL TX ELBOW DIS WO/ANES","code_information":[{"code":"24600","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":124.03,"maximum":2152,"gross_charge":528,"discounted_cash":248.74,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":332.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":332.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":332.64,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2152,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":1821,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":471.36,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":332.64,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":332.64,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":480.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":253.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":396,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":142.56,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":149.69,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":139.71,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":124.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":145.42,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":146.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":242.75,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":235.68,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":235.68,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":247.46,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":245.11,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":235.68,"methodology":"case rate"}]}]},{"description":"HC CLTX ELBOW DIS W/ANES","code_information":[{"code":"24605","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":2179.45,"maximum":2179.45,"gross_charge":2395,"discounted_cash":1128.25,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2179.45,"methodology":"fee schedule"}]}]},{"description":"HC CLTX ELBOW DIS W/ANES","code_information":[{"code":"24605","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":562.59,"maximum":3144.74,"gross_charge":2395,"discounted_cash":1128.25,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1508.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1508.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1508.85,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2376,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":2011,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":3144.74,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1508.85,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":1508.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1923.63,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2179.45,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1149.6,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":1796.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":646.65,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":678.99,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":633.72,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":562.59,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":659.59,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":666.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1619.54,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":1572.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1572.37,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":1650.99,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1635.26,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":1572.37,"methodology":"case rate"}]}]},{"description":"HC TREAT ELBOW DISLOCATION","code_information":[{"code":"24615","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":5092.36,"maximum":5092.36,"gross_charge":5596,"discounted_cash":2636.19,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5092.36,"methodology":"fee schedule"}]}]},{"description":"HC TREAT ELBOW DISLOCATION","code_information":[{"code":"24615","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":1314.51,"maximum":14037.14,"gross_charge":5596,"discounted_cash":2636.19,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3525.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3525.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3525.48,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":3796,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3212,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":14037.14,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3525.48,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3525.48,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2657.78,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5092.36,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2686.08,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":4197,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":1510.92,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":1586.47,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":1480.71,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":1314.51,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1541.14,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1556.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":7229.13,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":7369.5,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7299.31,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"}]}]},{"description":"HC CLTX MONTEGGGIA FX W MANIP","code_information":[{"code":"24620","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":546.91,"maximum":546.91,"gross_charge":601,"discounted_cash":283.13,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":546.91,"methodology":"fee schedule"}]}]},{"description":"HC CLTX MONTEGGGIA FX W MANIP","code_information":[{"code":"24620","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":141.18,"maximum":3144.74,"gross_charge":601,"discounted_cash":283.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":378.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":378.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":378.63,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2376,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":2011,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":3144.74,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":378.63,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":378.63,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1923.63,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":546.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":288.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":450.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":162.27,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":170.39,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":159.03,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":141.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":165.52,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":167.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1619.54,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":1572.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1572.37,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":1650.99,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1635.26,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":1572.37,"methodology":"case rate"}]}]},{"description":"HC TRT ELBOW FRAC W/INT FIXATION","code_information":[{"code":"24635","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":5092.36,"maximum":5092.36,"gross_charge":5596,"discounted_cash":2636.19,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5092.36,"methodology":"fee schedule"}]}]},{"description":"HC TRT ELBOW FRAC W/INT FIXATION","code_information":[{"code":"24635","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":1314.51,"maximum":14037.14,"gross_charge":5596,"discounted_cash":2636.19,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3525.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3525.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3525.48,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":3796,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3212,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":14037.14,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3525.48,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3525.48,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2657.78,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5092.36,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2686.08,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":4197,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":1510.92,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":1586.47,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":1480.71,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":1314.51,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1541.14,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1556.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":7229.13,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":7369.5,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7299.31,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"}]}]},{"description":"HC CL TX NRSMD ELBOW W/MA","code_information":[{"code":"24640","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":638.82,"maximum":638.82,"gross_charge":702,"discounted_cash":330.71,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":638.82,"methodology":"fee schedule"}]}]},{"description":"HC CL TX NRSMD ELBOW W/MA","code_information":[{"code":"24640","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":164.9,"maximum":1538.38,"gross_charge":702,"discounted_cash":330.71,"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 - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":372.06,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":329.94,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":471.36,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":442.26,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":442.26,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":638.82,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":336.96,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":526.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":189.54,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":199.02,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":185.75,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":164.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":193.34,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":195.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":242.75,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":235.68,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":235.68,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":247.46,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":245.11,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":235.68,"methodology":"case rate"}]}]},{"description":"HC CL TX RAD HD/NECK WO/MA","code_information":[{"code":"24650","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":404.04,"maximum":404.04,"gross_charge":444,"discounted_cash":209.17,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":404.04,"methodology":"fee schedule"}]}]},{"description":"HC CL TX RAD HD/NECK WO/MA","code_information":[{"code":"24650","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":104.3,"maximum":1538.38,"gross_charge":444,"discounted_cash":209.17,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":279.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":279.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":279.72,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":235.32,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":208.68,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":471.36,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":279.72,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":279.72,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":404.04,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":213.12,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":333,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":119.88,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":125.88,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":117.49,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":104.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":122.28,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":123.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":242.75,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":235.68,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":235.68,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":247.46,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":245.11,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":235.68,"methodology":"case rate"}]}]},{"description":"HC CL TX RAD HD/NECK W/MA","code_information":[{"code":"24655","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":520.52,"maximum":520.52,"gross_charge":572,"discounted_cash":269.46,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":520.52,"methodology":"fee schedule"}]}]},{"description":"HC CL TX RAD HD/NECK W/MA","code_information":[{"code":"24655","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":134.37,"maximum":3144.74,"gross_charge":572,"discounted_cash":269.46,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":360.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":360.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":360.36,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2152,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":1821,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":3144.74,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":360.36,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":360.36,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":520.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":274.56,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":429,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":154.44,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":162.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":151.36,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":134.37,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":157.53,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":159.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1619.54,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":1572.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1572.37,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":1650.99,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1635.26,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":1572.37,"methodology":"case rate"}]}]},{"description":"TREAT RADIUS FRACTURE","code_information":[{"code":"24665","type":"CPT"}],"standard_charges":[{"minimum":3078.06,"maximum":14037.14,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":4157,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3517,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":14037.14,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":3078.06,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":7229.13,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":7369.5,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7299.31,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"}]}]},{"description":"TREAT RADIUS FRACTURE","code_information":[{"code":"24666","type":"CPT"}],"standard_charges":[{"minimum":3078.06,"maximum":25282.78,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":4157,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3517,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":25282.78,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":3078.06,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":13020.63,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":12641.39,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":12641.39,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":13273.46,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":13147.05,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":12641.39,"methodology":"case rate"}]}]},{"description":"HC CL TX ULNAR FX WO/MA","code_information":[{"code":"24670","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":480.48,"maximum":480.48,"gross_charge":528,"discounted_cash":248.74,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":480.48,"methodology":"fee schedule"}]}]},{"description":"HC CL TX ULNAR FX WO/MA","code_information":[{"code":"24670","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":124.03,"maximum":2152,"gross_charge":528,"discounted_cash":248.74,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":332.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":332.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":332.64,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2152,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":1821,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":471.36,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":332.64,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":332.64,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":480.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":253.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":396,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":142.56,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":149.69,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":139.71,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":124.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":145.42,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":146.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":242.75,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":235.68,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":235.68,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":247.46,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":245.11,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":235.68,"methodology":"case rate"}]}]},{"description":"HC CLOSED TX ULNAR FRACTURE PROX END W MANIPULATION","code_information":[{"code":"24675","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":488.67,"maximum":488.67,"gross_charge":537,"discounted_cash":252.98,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":488.67,"methodology":"fee schedule"}]}]},{"description":"HC CLOSED TX ULNAR FRACTURE PROX END W MANIPULATION","code_information":[{"code":"24675","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":126.15,"maximum":3144.74,"gross_charge":537,"discounted_cash":252.98,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":338.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":338.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":338.31,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2152,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":1821,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":3144.74,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":338.31,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":338.31,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":488.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":257.76,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":402.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":144.99,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":152.24,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":142.1,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":126.15,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":147.89,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":149.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1619.54,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":1572.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1572.37,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":1650.99,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1635.26,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":1572.37,"methodology":"case rate"}]}]},{"description":"TREAT ULNAR FRACTURE","code_information":[{"code":"24685","type":"CPT"}],"standard_charges":[{"minimum":2657.78,"maximum":14037.14,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":3796,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3212,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":14037.14,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":2657.78,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":7229.13,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":7369.5,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7299.31,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"}]}]},{"description":"NO ACTIVE CODE DESCRIPTION","code_information":[{"code":"247","type":"MS-DRG"}],"standard_charges":[{"minimum":20088,"maximum":20088,"setting":"inpatient","payers_information":[{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":20088,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":20088,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"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":"248","type":"MS-DRG"}],"standard_charges":[{"minimum":20088,"maximum":20088,"setting":"inpatient","payers_information":[{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":20088,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":20088,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"FUSION OF ELBOW JOINT","code_information":[{"code":"24800","type":"CPT"}],"standard_charges":[{"minimum":3078.06,"maximum":14037.14,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":4157,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3517,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":14037.14,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":3078.06,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":7229.13,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":7369.5,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7299.31,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"}]}]},{"description":"FUSION/GRAFT OF ELBOW JOINT","code_information":[{"code":"24802","type":"CPT"}],"standard_charges":[{"minimum":3497.02,"maximum":25282.78,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":4514,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3819,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":25282.78,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":3497.02,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":13020.63,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":12641.39,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":12641.39,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":13273.46,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":13147.05,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":12641.39,"methodology":"case rate"}]}]},{"description":"NO ACTIVE CODE DESCRIPTION","code_information":[{"code":"249","type":"MS-DRG"}],"standard_charges":[{"minimum":20088,"maximum":20088,"setting":"inpatient","payers_information":[{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":20088,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":20088,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"AMPUTATION OF UPPER ARM","code_information":[{"code":"24900","type":"CPT"}],"standard_charges":[{"minimum":1923.63,"maximum":1923.63,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"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|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1923.63,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"AMPUTATION OF UPPER ARM","code_information":[{"code":"24920","type":"CPT"}],"standard_charges":[{"minimum":3917.28,"maximum":3917.28,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"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|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":3917.28,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"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":2657.78,"maximum":6375.52,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":3796,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3212,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":6375.52,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":2657.78,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3283.39,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":3187.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3187.76,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":3347.15,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3315.27,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":3187.76,"methodology":"case rate"}]}]},{"description":"AMPUTATION FOLLOW-UP SURGERY","code_information":[{"code":"24930","type":"CPT"}],"standard_charges":[{"minimum":1538.38,"maximum":1538.38,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"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|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"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":1923.63,"maximum":1923.63,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"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|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1923.63,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"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":5385.62,"maximum":14037.14,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":14037.14,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":5385.62,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":7229.13,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":7369.5,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7299.31,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"}]}]},{"description":"REVISION OF UPPER ARM","code_information":[{"code":"24940","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"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|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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":52,"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":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"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":235.68,"maximum":1538.38,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":471.36,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":242.75,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":235.68,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":235.68,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":247.46,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":245.11,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":235.68,"methodology":"case rate"}]}]},{"description":"PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITHOUT INTRALUMINAL DEVICE WITH MCC","code_information":[{"code":"250","type":"MS-DRG"}],"standard_charges":[{"minimum":13208,"maximum":36414,"setting":"inpatient","payers_information":[{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":34821,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":36414,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":33222.72,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13208,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":13208,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":28941,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":34222,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":31567,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":14202.72,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":16569.84,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":15780.8,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":16096.42,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":16096.42,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":16096.42,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":17109.71,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":16694.42,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":16611.36,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":17441.93,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":17026.65,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":16611.36,"methodology":"case rate"}]}]},{"description":"INCISION OF TENDON SHEATH","code_information":[{"code":"25000","type":"CPT"}],"standard_charges":[{"minimum":1572.37,"maximum":3796,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":3796,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3212,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":3144.74,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":2657.78,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1619.54,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":1572.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1572.37,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":1650.99,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1635.26,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":1572.37,"methodology":"case rate"}]}]},{"description":"INCISE FLEXOR CARPI RADIALIS","code_information":[{"code":"25001","type":"CPT"}],"standard_charges":[{"minimum":1538.38,"maximum":6375.52,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":6375.52,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3283.39,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":3187.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3187.76,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":3347.15,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3315.27,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":3187.76,"methodology":"case rate"}]}]},{"description":"DECOMPRESS FOREARM 1 SPACE","code_information":[{"code":"25020","type":"CPT"}],"standard_charges":[{"minimum":1572.37,"maximum":3796,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":3796,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3212,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":3144.74,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":2657.78,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1619.54,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":1572.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1572.37,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":1650.99,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1635.26,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":1572.37,"methodology":"case rate"}]}]},{"description":"DECOMPRESS FOREARM 1 SPACE","code_information":[{"code":"25023","type":"CPT"}],"standard_charges":[{"minimum":2657.78,"maximum":6375.52,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":3796,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3212,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":6375.52,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":2657.78,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3283.39,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":3187.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3187.76,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":3347.15,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3315.27,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":3187.76,"methodology":"case rate"}]}]},{"description":"DECOMPRESS FOREARM 2 SPACES","code_information":[{"code":"25024","type":"CPT"}],"standard_charges":[{"minimum":2657.78,"maximum":6375.52,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":3796,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3212,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":6375.52,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":2657.78,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3283.39,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":3187.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3187.76,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":3347.15,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3315.27,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":3187.76,"methodology":"case rate"}]}]},{"description":"DECOMPRESS FOREARM 2 SPACES","code_information":[{"code":"25025","type":"CPT"}],"standard_charges":[{"minimum":1572.37,"maximum":3796,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":3796,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3212,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":3144.74,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":2657.78,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1619.54,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":1572.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1572.37,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":1650.99,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1635.26,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":1572.37,"methodology":"case rate"}]}]},{"description":"DRAINAGE OF FOREARM LESION","code_information":[{"code":"25028","type":"CPT"}],"standard_charges":[{"minimum":1538.38,"maximum":6375.52,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2152,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":1821,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":6375.52,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3283.39,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":3187.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3187.76,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":3347.15,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3315.27,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":3187.76,"methodology":"case rate"}]}]},{"description":"DRAINAGE OF FOREARM BURSA","code_information":[{"code":"25031","type":"CPT"}],"standard_charges":[{"minimum":1572.37,"maximum":3144.74,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2376,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":2011,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":3144.74,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1923.63,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1619.54,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":1572.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1572.37,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":1650.99,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1635.26,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":1572.37,"methodology":"case rate"}]}]},{"description":"TREAT FOREARM BONE LESION","code_information":[{"code":"25035","type":"CPT"}],"standard_charges":[{"minimum":1923.63,"maximum":14037.14,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2376,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":2011,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":14037.14,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1923.63,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":7229.13,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":7369.5,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7299.31,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"}]}]},{"description":"EXPLORE/TREAT WRIST JOINT","code_information":[{"code":"25040","type":"CPT"}],"standard_charges":[{"minimum":3187.76,"maximum":6375.52,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":4514,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3819,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":6375.52,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":3497.02,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3283.39,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":3187.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3187.76,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":3347.15,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3315.27,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":3187.76,"methodology":"case rate"}]}]},{"description":"BIOPSY FOREARM SOFT TISSUES","code_information":[{"code":"25065","type":"CPT"}],"standard_charges":[{"minimum":1538.38,"maximum":3183.7,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":3183.7,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1639.61,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":1591.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1591.85,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":1671.44,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1655.52,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":1591.85,"methodology":"case rate"}]}]},{"description":"BIOPSY FOREARM SOFT TISSUES","code_information":[{"code":"25066","type":"CPT"}],"standard_charges":[{"minimum":1923.63,"maximum":5623.82,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2376,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":2011,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":5623.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1923.63,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2896.27,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":2811.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2811.91,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":2952.51,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2924.39,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":2811.91,"methodology":"case rate"}]}]},{"description":"EXC FOREARM LES SC 3 CM/>","code_information":[{"code":"25071","type":"CPT"}],"standard_charges":[{"minimum":1538.38,"maximum":3183.7,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2376,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":2011,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":3183.7,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"median_amount":1984.42,"10th_percentile":1984.42,"90th_percentile":1984.42,"count":"1 through 10","methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"median_amount":1984.42,"10th_percentile":1984.42,"90th_percentile":1984.42,"count":"1 through 10","methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1639.61,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":1591.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1591.85,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":1671.44,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1655.52,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":1591.85,"methodology":"case rate"}]}]},{"description":"EXC FOREARM TUM DEEP 3 CM/>","code_information":[{"code":"25073","type":"CPT"}],"standard_charges":[{"minimum":1538.38,"maximum":5623.82,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":3796,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3212,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":5623.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2896.27,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":2811.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2811.91,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":2952.51,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2924.39,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":2811.91,"methodology":"case rate"}]}]},{"description":"EXC FOREARM LES SC < 3 CM","code_information":[{"code":"25075","type":"CPT"}],"standard_charges":[{"minimum":1591.85,"maximum":3183.7,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2376,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":2011,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":3183.7,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1923.63,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"median_amount":1048.6,"10th_percentile":1048.6,"90th_percentile":1048.6,"count":"1 through 10","methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1639.61,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":1591.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1591.85,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":1671.44,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1655.52,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":1591.85,"methodology":"case rate"}]}]},{"description":"EXC FOREARM TUM DEEP < 3 CM","code_information":[{"code":"25076","type":"CPT"}],"standard_charges":[{"minimum":1591.85,"maximum":3796,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":3796,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3212,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":3183.7,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":2657.78,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1639.61,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":1591.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1591.85,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":1671.44,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1655.52,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":1591.85,"methodology":"case rate"}]}]},{"description":"RESECT FOREARM/WRIST TUM<3CM","code_information":[{"code":"25077","type":"CPT"}],"standard_charges":[{"minimum":2657.78,"maximum":5623.82,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":3796,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3212,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":5623.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":2657.78,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2896.27,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":2811.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2811.91,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":2952.51,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2924.39,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":2811.91,"methodology":"case rate"}]}]},{"description":"RESECT FORARM/WRIST TUM 3CM>","code_information":[{"code":"25078","type":"CPT"}],"standard_charges":[{"minimum":1538.38,"maximum":5623.82,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":3796,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3212,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":5623.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2896.27,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":2811.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2811.91,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":2952.51,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2924.39,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":2811.91,"methodology":"case rate"}]}]},{"description":"INCISION OF WRIST CAPSULE","code_information":[{"code":"25085","type":"CPT"}],"standard_charges":[{"minimum":2657.78,"maximum":6375.52,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":3796,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3212,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":6375.52,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":2657.78,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3283.39,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":3187.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3187.76,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":3347.15,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3315.27,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":3187.76,"methodology":"case rate"}]}]},{"description":"PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITHOUT INTRALUMINAL DEVICE WITHOUT MCC","code_information":[{"code":"251","type":"MS-DRG"}],"standard_charges":[{"minimum":9691.65,"maximum":24605,"setting":"inpatient","payers_information":[{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":23528,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":24605,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":22670.52,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13208,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":13208,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":19555,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":23123,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":21329,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":9691.65,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":11306.93,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":10768.5,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":10983.87,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":10983.87,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":10983.87,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":11675.32,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":11391.94,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":11335.26,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":11902.03,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":11618.65,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":11335.26,"methodology":"case rate"}]}]},{"description":"BIOPSY OF WRIST JOINT","code_information":[{"code":"25100","type":"CPT"}],"standard_charges":[{"minimum":1923.63,"maximum":6375.52,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2376,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":2011,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":6375.52,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1923.63,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3283.39,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":3187.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3187.76,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":3347.15,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3315.27,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":3187.76,"methodology":"case rate"}]}]},{"description":"EXPLORE/TREAT WRIST JOINT","code_information":[{"code":"25101","type":"CPT"}],"standard_charges":[{"minimum":2657.78,"maximum":6375.52,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":3796,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3212,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":6375.52,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":2657.78,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3283.39,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":3187.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3187.76,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":3347.15,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3315.27,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":3187.76,"methodology":"case rate"}]}]},{"description":"REMOVE WRIST JOINT LINING","code_information":[{"code":"25105","type":"CPT"}],"standard_charges":[{"minimum":3078.06,"maximum":6375.52,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":4157,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3517,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":6375.52,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":3078.06,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3283.39,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":3187.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3187.76,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":3347.15,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3315.27,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":3187.76,"methodology":"case rate"}]}]},{"description":"REMOVE WRIST JOINT CARTILAGE","code_information":[{"code":"25107","type":"CPT"}],"standard_charges":[{"minimum":2657.78,"maximum":6375.52,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":3796,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3212,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":6375.52,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":2657.78,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3283.39,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":3187.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3187.76,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":3347.15,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3315.27,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":3187.76,"methodology":"case rate"}]}]},{"description":"EXCISE TENDON FOREARM/WRIST","code_information":[{"code":"25109","type":"CPT"}],"standard_charges":[{"minimum":1538.38,"maximum":6375.52,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":6375.52,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3283.39,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":3187.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3187.76,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":3347.15,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3315.27,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":3187.76,"methodology":"case rate"}]}]},{"description":"REMOVE WRIST TENDON LESION","code_information":[{"code":"25110","type":"CPT"}],"standard_charges":[{"minimum":1572.37,"maximum":3796,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":3796,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3212,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":3144.74,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":2657.78,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1619.54,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":1572.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1572.37,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":1650.99,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1635.26,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":1572.37,"methodology":"case rate"}]}]},{"description":"REMOVE WRIST TENDON LESION","code_information":[{"code":"25111","type":"CPT"}],"standard_charges":[{"minimum":1572.37,"maximum":3796,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":3796,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3212,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":3144.74,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":2657.78,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1619.54,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":1572.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1572.37,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":1650.99,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1635.26,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":1572.37,"methodology":"case rate"}]}]},{"description":"REREMOVE WRIST TENDON LESION","code_information":[{"code":"25112","type":"CPT"}],"standard_charges":[{"minimum":1572.37,"maximum":4157,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":4157,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3517,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":3144.74,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":3078.06,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1619.54,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":1572.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1572.37,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":1650.99,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1635.26,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":1572.37,"methodology":"case rate"}]}]},{"description":"REMOVE WRIST/FOREARM LESION","code_information":[{"code":"25115","type":"CPT"}],"standard_charges":[{"minimum":1572.37,"maximum":4157,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":4157,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3517,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":3144.74,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":3078.06,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1619.54,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":1572.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1572.37,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":1650.99,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1635.26,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":1572.37,"methodology":"case rate"}]}]},{"description":"REMOVE WRIST/FOREARM LESION","code_information":[{"code":"25116","type":"CPT"}],"standard_charges":[{"minimum":3078.06,"maximum":6375.52,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":4157,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3517,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":6375.52,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":3078.06,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3283.39,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":3187.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3187.76,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":3347.15,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3315.27,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":3187.76,"methodology":"case rate"}]}]},{"description":"EXCISE WRIST TENDON SHEATH","code_information":[{"code":"25118","type":"CPT"}],"standard_charges":[{"minimum":1572.37,"maximum":3144.74,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2376,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":2011,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":3144.74,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1923.63,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1619.54,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":1572.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1572.37,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":1650.99,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1635.26,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":1572.37,"methodology":"case rate"}]}]},{"description":"PARTIAL REMOVAL OF ULNA","code_information":[{"code":"25119","type":"CPT"}],"standard_charges":[{"minimum":2657.78,"maximum":6375.52,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":3796,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3212,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":6375.52,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":2657.78,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3283.39,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":3187.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3187.76,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":3347.15,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3315.27,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":3187.76,"methodology":"case rate"}]}]},{"description":"REMOVAL OF FOREARM LESION","code_information":[{"code":"25120","type":"CPT"}],"standard_charges":[{"minimum":2657.78,"maximum":6375.52,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":3796,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3212,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":6375.52,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":2657.78,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3283.39,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":3187.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3187.76,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":3347.15,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3315.27,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":3187.76,"methodology":"case rate"}]}]},{"description":"REMOVE/GRAFT FOREARM LESION","code_information":[{"code":"25125","type":"CPT"}],"standard_charges":[{"minimum":1572.37,"maximum":3796,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":3796,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3212,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":3144.74,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":2657.78,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1619.54,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":1572.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1572.37,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":1650.99,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1635.26,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":1572.37,"methodology":"case rate"}]}]},{"description":"REMOVE/GRAFT FOREARM LESION","code_information":[{"code":"25126","type":"CPT"}],"standard_charges":[{"minimum":2657.78,"maximum":6375.52,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":3796,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3212,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":6375.52,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":2657.78,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3283.39,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":3187.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3187.76,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":3347.15,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3315.27,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":3187.76,"methodology":"case rate"}]}]},{"description":"REMOVAL OF WRIST LESION","code_information":[{"code":"25130","type":"CPT"}],"standard_charges":[{"minimum":2657.78,"maximum":6375.52,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":3796,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3212,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":6375.52,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":2657.78,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3283.39,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":3187.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3187.76,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":3347.15,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3315.27,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":3187.76,"methodology":"case rate"}]}]},{"description":"REMOVE  GRAFT WRIST LESION","code_information":[{"code":"25135","type":"CPT"}],"standard_charges":[{"minimum":2657.78,"maximum":14037.14,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":3796,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3212,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":14037.14,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":2657.78,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":7229.13,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":7369.5,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7299.31,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"}]}]},{"description":"REMOVE  GRAFT WRIST LESION","code_information":[{"code":"25136","type":"CPT"}],"standard_charges":[{"minimum":2657.78,"maximum":14037.14,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":3796,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3212,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":14037.14,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":2657.78,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":7229.13,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":7369.5,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7299.31,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"}]}]},{"description":"REMOVE FOREARM BONE LESION","code_information":[{"code":"25145","type":"CPT"}],"standard_charges":[{"minimum":1923.63,"maximum":6375.52,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2376,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":2011,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":6375.52,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1923.63,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3283.39,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":3187.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3187.76,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":3347.15,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3315.27,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":3187.76,"methodology":"case rate"}]}]},{"description":"PARTIAL REMOVAL OF ULNA","code_information":[{"code":"25150","type":"CPT"}],"standard_charges":[{"minimum":1923.63,"maximum":6375.52,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2376,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":2011,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":6375.52,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1923.63,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3283.39,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":3187.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3187.76,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":3347.15,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3315.27,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":3187.76,"methodology":"case rate"}]}]},{"description":"PARTIAL REMOVAL OF RADIUS","code_information":[{"code":"25151","type":"CPT"}],"standard_charges":[{"minimum":1923.63,"maximum":6375.52,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2376,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":2011,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":6375.52,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1923.63,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3283.39,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":3187.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3187.76,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":3347.15,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3315.27,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":3187.76,"methodology":"case rate"}]}]},{"description":"RESECT RADIUS/ULNAR TUMOR","code_information":[{"code":"25170","type":"CPT"}],"standard_charges":[{"minimum":2657.78,"maximum":14037.14,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":14037.14,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":2657.78,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":7229.13,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":7369.5,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7299.31,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.57,"methodology":"case rate"}]}]},{"description":"OTHER VASCULAR PROCEDURES WITH MCC","code_information":[{"code":"252","type":"MS-DRG"}],"standard_charges":[{"minimum":20926,"maximum":51652,"setting":"inpatient","payers_information":[{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":51652,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":46187,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":48949.7,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":42930,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":50763,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":46825,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":20926,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":24413.67,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":23251.11,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":23716.14,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":23716.14,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":23716.14,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":25209.1,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":24597.23,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":24474.85,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":25698.6,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":25086.73,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":24474.85,"methodology":"case rate"}]}]},{"description":"REMOVAL OF WRIST BONE","code_information":[{"code":"25210","type":"CPT"}],"standard_charges":[{"minimum":2657.78,"maximum":6375.52,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":3796,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3212,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":6375.52,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":2657.78,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3283.39,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":3187.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3187.76,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":3347.15,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3315.27,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":3187.76,"methodology":"case rate"}]}]},{"description":"REMOVAL OF WRIST BONES","code_information":[{"code":"25215","type":"CPT"}],"standard_charges":[{"minimum":3078.06,"maximum":6375.52,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":4157,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3517,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":6375.52,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":3078.06,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3283.39,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":3187.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3187.76,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":3347.15,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3315.27,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":3187.76,"methodology":"case rate"}]}]},{"description":"PARTIAL REMOVAL OF RADIUS","code_information":[{"code":"25230","type":"CPT"}],"standard_charges":[{"minimum":3078.06,"maximum":6375.52,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":4157,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3517,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":6375.52,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":3078.06,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3283.39,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":3187.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3187.76,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":3347.15,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3315.27,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":3187.76,"methodology":"case rate"}]}]},{"description":"PARTIAL REMOVAL OF ULNA","code_information":[{"code":"25240","type":"CPT"}],"standard_charges":[{"minimum":3078.06,"maximum":6375.52,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":4157,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":3517,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":6375.52,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":3078.06,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3283.39,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":3187.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3187.76,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":3347.15,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3315.27,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":3187.76,"methodology":"case rate"}]}]},{"description":"HC INJ FOR WRIST X-RAY","code_information":[{"code":"25246","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":161.07,"maximum":161.07,"gross_charge":177,"discounted_cash":83.39,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":161.07,"methodology":"fee schedule"}]}]},{"description":"HC INJ FOR WRIST X-RAY","code_information":[{"code":"25246","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":41.58,"maximum":1538.38,"gross_charge":177,"discounted_cash":83.39,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":111.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":111.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":111.51,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":111.51,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":111.51,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":161.07,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":84.96,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|PPO","standard_charge_dollar":132.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_dollar":47.79,"methodology":"fee schedule"},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_dollar":50.18,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_dollar":46.84,"methodology":"fee schedule"},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_dollar":41.58,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":48.75,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":49.23,"methodology":"fee schedule"}]}]},{"description":"REMOVE FOREARM FOREIGN BODY","code_information":[{"code":"25248","type":"CPT"}],"standard_charges":[{"minimum":1572.37,"maximum":3144.74,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2376,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":2011,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":3144.74,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1923.63,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1619.54,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":1572.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1572.37,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":1650.99,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1635.26,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":1572.37,"methodology":"case rate"}]}]},{"description":"REMOVAL OF WRIST PROSTHESIS","code_information":[{"code":"25250","type":"CPT"}],"standard_charges":[{"minimum":1538.38,"maximum":3144.74,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2152,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":1821,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":3144.74,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1619.54,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":1572.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1572.37,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":1650.99,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1635.26,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":1572.37,"methodology":"case rate"}]}]},{"description":"REMOVAL OF WRIST PROSTHESIS","code_information":[{"code":"25251","type":"CPT"}],"standard_charges":[{"minimum":1538.38,"maximum":6375.52,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|HMO PPO","standard_charge_dollar":2152,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Commercial|Pathway","standard_charge_dollar":1821,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":6375.52,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3283.39,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":3187.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3187.76,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":3347.15,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3315.27,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":3187.76,"methodology":"case rate"}]}]},{"description":"MANIPULATE WRIST W/ANESTHES","code_information":[{"code":"25259","type":"CPT"}],"standard_charges":[{"minimum":1538.38,"maximum":3144.74,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":63,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Commercial|All Plans","standard_charge_dollar":3144.74,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":63,"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|PPO","standard_charge_percentage":63,"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_dollar":1538.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":91,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|All Other Plans","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":"United","plan_name":"Commercial|PPO","standard_charge_percentage":75,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid|Better Health","standard_charge_percentage":27,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - Anthem","plan_name":"Medicaid|All Plans","standard_charge_percentage":28.35,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid|All Plans","standard_charge_percentage":26.46,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Passport by Molina","plan_name":"Medicaid|All Plans","standard_charge_percentage":23.49,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.54,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":27.81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1619.54,"methodology":"case rate"},{"payer_name":"BCBS - Anthem","plan_name":"Medicare|All Plans","standard_charge_dollar":1572.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1572.37,"methodology":"case rate"},{"payer_name":"Passport by Molina","plan_name":"Medicare|All Plans","standard_charge_dollar":1650.99,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1635.26,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicare|All Plans","standard_charge_dollar":1572.37,"methodology":"case rate"}]}]},{"description":"HC REPAIR TEND/MSCL FARM WRST","code_information":[{"code":"25260","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":3623.62,"maximum":3623.62,"gross_charge":3982,"discounted_cash":1875.86,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3623.62,"methodology":"fee schedule"}]}]},{"description":"HC REPAIR TEND/MSCL FARM WRST","code_information":[{"code":"25260","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":935.38,"maximum":6375.52,"gross_charge":3982,"discounted_cash":1875.86,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_n